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©The Author(s) 2022.
World J Meta-Anal. Aug 28, 2022; 10(4): 220-237
Published online Aug 28, 2022. doi: 10.13105/wjma.v10.i4.220
Published online Aug 28, 2022. doi: 10.13105/wjma.v10.i4.220
Table 1 Summary of patient characteristics of included randomised controlled trials and cohort studies
Ref. | Design | Country | Year | Arms | NP | Age/yr | % males | NL | Tumour size, mean or median (range or SD)/mm | CPC (A/B/C) | F/U Duration/mo |
Abdelaziz et al[72], 2014 | RCT | Egypt | 2009-2011 | MWA | 66 | 53.6 (48.6-58.6) | 72.7 | 76 | 29 (19.3-38.7) | 25/41/0 | NR |
RFA | 45 | 56.8 (49.5-64.1) | 68.9 | 52 | 29.5 (19.2-39.8) | 24/21/0 | |||||
Chong et al[34], 2020 | RCT | Hong Kong | 2011-2017 | MWA | 47 | 63 (50–80) | 63.8 | NR | 31 (20–45) | 39/7/1 | 38.3 (2.3–78.0) |
RFA | 46 | 64.5 (42–5) | 82.6 | 28 (20–55) | 40/6/0 | 33.9 (4.9–72.7) | |||||
Kamal et al[35], 2019 | RCT | Egypt | 2017 | MWA | 28 | 55 (42-80) | 75 | 34 | 32.5 (23.3-41.7) | 22/6/0 | 12 |
RFA | 28 | 55 (42-80) | 78.6 | 34 | 32.8 (23.7-41.9) | 22/6/0 | 12 | ||||
Qian et al[36], 2012 | RCT | China | 2009-2010 | MWA | 22 | 52 (43–75) | 90.9 | 22 | 21 (17-25) | 22/0/0 | 5.1 ± 1.3 (2.8-6.5) |
RFA | 20 | 56 (43–76) | 95 | 20 | 20 (15-25) | 20/0/0 | 5.1 ± 1.3 (2.8-6.5) | ||||
Shibata et al[23], 2002 | RCT | Japan | 1999-2000 | MWA | 36 | 62.5 (52–74) | 66.7 | 46 | 22 (9–34) | 19/17/0 | 18 (6-27) |
RFA | 36 | 63.6 (44–83) | 72.7 | 48 | 23 (10–37) | 21/15/0 | 18 (6-27) | ||||
Tian et al[37], 2014 | RCT | China | 2014 | MWA | 120 | NR | NR | 86 | 26 (13-39) | NR | NR |
RFA | 79 | 22 (13-31) | |||||||||
Vietti et al[38], 2018 | RCT | France & Switzerland | 2011-2015 | MWA | 76 | NR | NR | 98 | NR | NR | 26 (18-29) |
RFA | 76 | 104 | 25 (18-34) | ||||||||
Yu et al[22], 2017 | RCT | China | 2008-2015 | MWA | 203 | NR | NR | 265 | 27 (7– 50) | NR | 35.2 (2.0–81.9) |
RFA | 200 | 251 | 26 (9–50) | 35.2 (2.0–81.9) | |||||||
Abdel-Samiee et al[33], 2020 | Retro | Egypt | 2020 | MWA | 50 | NR | NR | NR | NR | NR | 36 |
RFA | 50 | 36 | |||||||||
Bouda et al[39], 2020 | Retro | France | 2008-2016 | MWA | 79 | 62.8 (52.4-73.2) | 81 | 99 | 21.3 (13-29.6) | 71/8/0 | 34 (3–65) |
RFA | 43 | 62.2 (50.3-74.1) | 76.7 | 52 | 23.0 (14.9-31.1) | 39/4/0 | 40 (5–126) | ||||
Chinnaratha et al[40], 2014 | Retro | Australia | 2006-2012 | MWA | 101 | 62.1 (51.7-72.5) | 98 | NR | 21.1 (10.9-31.3) | 92/23/2 | 36 |
RFA | 25 | 62.1 (51.7-72.5) | 98 | 21.1 (10.9-31.3) | 36 | ||||||
Cillo et al[41], 2014 | Pros/Retro | Italy | 2004-2010 | MWA | 42 | 64 (47–81) | 83 | 50 | NR | 24 | |
RFA | 100 | 63 (34–81) | 83 | NR | 24 | ||||||
Ciruolo et al[42], 2020 | Retro | Italy | 2013-2019 | MWA | NR | 64 | 71.7 | 78 | NR | NR | NR |
RFA | 172 | ||||||||||
Ding et al[43], 2013 | Retro | China | 2006-2010 | MWA | 113 | 59.06 (30–86) | 75.2 | 131 | 25.5 (8–50) | 75/38/0 | 18.3 (3–51.4) |
RFA | 85 | 58.64 (40–77) | 80 | 98 | 23.8 (10–48) | 49/36/0 | 27.7 (4–60) | ||||
Du et al[44], 2020 | Retro | China | 2014-2016 | MWA | 218 | 56.3 (46.3-66.3) | 80 | 136 | 24 (13-35) | 107/8/0 | 28 (15-51) |
RFA | 234 | 57.5 (48-67) | 76.5 | 137 | 26 (15-37) | 105/10/0 | |||||
Gaia et al[45], 2021 | Retro | Italy | 2013-2019 | MWA | 81 | 67 (57–73) | 76.5 | 77 | 29 (20–35) | 71/10/0 | 20.4 (10.8-38.4) |
RFA | 170 | 63 (56–72) | 69.4 | 169 | 20 (15–25) | 148/22/0 | 34.8 (19.2–51.6) | ||||
Ghweil et al[46], 2019 | Pros | Egypt | 2019 | MWA | 25 | NR | NR | NR | NR | NR | NR |
RFA | 30 | ||||||||||
Iida et al[47], 2013 | Retro | Japan | 2001-2012 | MWA | 40 | 70.1 (63.5-76.7) | NR | NR | 20 (11-29) | NR | NR |
RFA | 18 | 73.5 (69.5-77.5) | 21 (16-26) | ||||||||
Ding et al[48], 2013 | Retro | China | 2002-2011 | MWA | 556 | 58.4 (48.1-68.7) | 74.8 | 1090 | 23 (12-34) | 466/167/22 | (6-75) |
RFA | 323 | 58 (47.8-68.3) | 79.8 | 562 | 22.8 (11.7-33.9) | 248/106/22 | (6-75) | ||||
Kuang et al[49], 2011 | Pros | China | 1997-2008 | MWA | 19 | 55 (27-74) | 94 | NR | NR | 77/4 /0 | 45 (24-155) |
RFA | 31 | ||||||||||
Kumbar et al[50], 2018 | Retro | India | 2018 | MWA | 25 | (40-85) | 92 | 33 | NR | 13/8/4 | 15 |
RFA | 25 | 88 | 35 | 17/8/0 | |||||||
Lee et al[51], 2017 | Retro | Hong Kong | 2003-2011 | MWA | 26 | 62.5 (49-79) | 73.1 | 28 | 37.5 (20-60) | 23/3/0 | 47.5 (11.3-62.5) |
RFA | 47 | 58 (43-77) | 85.1 | 52 | 31 (20-60) | 42/5/0 | 52.9 (3.6-121.8) | ||||
Liu et al[52], 2018 | Retro | China | 2002-2017 | MWA | 126 | 54 (45, 60) | 90.5 | 162 | 22.5 (17, 29) | NR | 36.8 (1-115) |
RFA | 436 | 56 (46, 65) | 89.7 | 482 | 23.0 (18, 30) | 34.1 (1-171) | |||||
Loriaud et al[53], 2018 | Retro | France & Switzerland | 2007-2015 | MWA | NR | 69 (61–75) | 92.5 | 40 | 22.5 (10–47) | 40/0/0 | 28 (10-46) |
RFA | 67 (58-74) | 85.8 | 120 | 21.3 (10-46) | 111/9/0 | ||||||
Lu et al[54], 2005 | Retro | China | 1997-2002 | MWA | 49 | 50.1 (24–74) | 89.8 | 98 | 25 (9–72) | 22/27/0 | 25.1 (2.0–50.6) |
RFA | 53 | 54.5 (20–74) | 81.1 | 72 | 26 (10–61) | 47/6/0 | 24.8 (2.0–51.0) | ||||
Mocan et al[55], 2017 | Retro | Romania | 2010-2016 | MWA | NR | NR | NR | 22 | NR | NR | 12 (5.6-18.4) |
RFA | 79 | 22.8 (7.8-37.4) | |||||||||
Nocerino et al[56], 2016 | Retro | Italy | 2016 | MWA | 106 | NR | NR | 134 | 20.4 (11-37) | NR | 12 (5.6-18.4) |
RFA | 27 | 35 | 20.1 (7-34) | 22.8 (7.8-37.4) | |||||||
Ohmoto et al[57], 2008 | Retro | Japan | 2002-2006 | MWA | 49 | 64 (38–75) | 83.7 | 56 | 17 (8–20) | 31/14/4 | 33.5 (9.8-57.2) |
RFA | 34 | 67 (44–78) | 73.5 | 37 | 16 (7–20) | 20/11/3 | 25.9 (14.6-37.2) | ||||
Potretzke et al[58], 2016 | Retro | US | 2001-2013 | MWA | 99 | 61 (44–82) | 81.8 | 136 | 22 (20–23) | NR | 24 |
RFA | 55 | 62 (23–88) | 72.7 | 69 | 24 (22–26) | 31 | |||||
Sakaguchi et al[59], 2009 | Pros | Japan | 2009 | MWA | 142 | NR | NR | NR | NR | NR | NR |
RFA | 249 | ||||||||||
Santambrogio et al[60], 2017 | Retro | Italy | 2009-2015 | MWA | 60 | 70 (61.7-78.3) | 72 | NR | 21.5 (16.2-26.8) | 60/0/0 | 31 (15–46) |
RFA | 94 | 69 (60-78) | 73 | 19.2 (14.2-24.2) | 94/0/0 | ||||||
Sever et al[61], 2018 | Retro | Turkey | 2012-2015 | MWA | 20 | 63.6 (57.3-69.9) | 65 | 37 | 28 (18-38) | 14/4/2 | 12 (1-40) |
RFA | 20 | 64.3 (55.3-73.3) | 70 | 34 | 24 (13-35) | 11/4/5 | |||||
Shum et al[62], 2016 | Retro | Hong Kong | 2014-2015 | MWA | 22 | NR | NR | NR | NR | NR | 19 |
RFA | 44 | 18 | |||||||||
Simo et al[63], 2011 | Retro | US | 2006-2008 | MWA | 13 | 59.6 (49–72) | 54 | 15 | 23.1 (14–39) | 12/7/3 | 7 (2.5–10.5) |
RFA | 22 | 58 (45–79) | 86 | 27 | 25.3 (12–44) | 7/6/0 | 19 (1.5–31) | ||||
Suwa et al[64], 2021 | Retro | Japan | 2014-2020 | MWA | 72 | 74.9 (66.5-83.3) | 65.3 | NR | 17.7 (10.9-24.5) | 58/14/0 | 12 |
RFA | 72 | 74.4 (65.2-83.6) | 68.1 | NR | 17.6 (11.3-23.9) | 61/11/0 | 37.8 | ||||
Suwa et al[65], 2020 | Retro | Japan | 2016-2019 | MWA | 44 | 73.4 (65.7-81.1) | 68 | 52 | 17.2 (12.3-22.1) | 12/3/29 | NR |
RFA | 55 | 73.4 (65.7-81.1) | 80 | 70 | 17.7 (11.3-24.1) | 16/8/31 | |||||
Vogl et al[66], 2015 | Retro | Egypt | 2008-2010 | MWA | 28 | 60 (45-68) | 82.1 | 32 | 36 (9-50) | NR | NR |
RFA | 25 | 57 (40-64) | 76 | 36 | 32 (8-45) | ||||||
Xu et al[67], 2004 | Retro | China | 1997-2001 | MWA | 54 | 53.4 (24–74) | 86.6 | 112 | 25 (15-36) | 53/33/11 | 27.4 (2–53) |
RFA | 43 | 78 | 26 (12-40) | ||||||||
Xu et al[68], 2017 | Retro | China | 2007-2012 | MWA | 301 | 54.2 (43.2-65.2) | 78.1 | NR | 17 (14-20) | 278/23/0 | 53 (8–98) |
RFA | 159 | 54.0 (43-65) | 83 | 17 (14-20) | 140/19/0 | 62 (6–102) | |||||
Yin et al[69], 2009 | Retro | China | 1997-2007 | MWA | 49 | 53 (41-65) | 87.2 | NR | 39 (31-47) | NR | 22 (2.2-93.5) |
RFA | 59 | ||||||||||
Zhang et al[70], 2013 | Retro | China | 2006 | MWA | 77 | 54 (26–76) | 70.2 | 105 | NR | 77/0/0 | 24.5 (6–64) |
RFA | 78 | 54 (30–80) | 82.1 | 93 | 78/0/0 | 26.3 (7–65.6) | |||||
Zhang et al[71], 2014 | Pros | China | 2014 | MWA | 45 | NR | NR | 60 | NR | NR | NR |
RFA | 56 | 68 |
Table 2 Summary of the comparison of OS and local recurrence rates between microwave ablation versus radiofrequency ablation for intrahepatic hepatocellular lesions in both cohort studies and RCTs according to year of follow-up
Endpoint | Study design | No. of studies | OR | 95%CI | P for significance | I2 | P for heterogeneity |
Overall survival – OR | |||||||
1Y | Prospective | 1 | 3.00 | 0.33-27.48 | 0.331 | - | - |
Retrospective | 11 | 1.19 | 0.71-1.99 | 0.513 | 0 | 0.72 | |
RCT | 4 | 1.95 | 0.71-5.34 | 0.194 | 35.5 | 0.20 | |
2Y | Retrospective | 7 | 1.27 | 0.75-2.18 | 0.377 | 36.6 | 0.15 |
RCT | 1 | 1.84 | 0.54-6.28 | 0.333 | - | - | |
3Y | Prospective | 1 | 1.69 | 0.59-4.81 | 0.328 | - | - |
Retrospective | 9 | 1.14 | 0.75-1.73 | 0.554 | 58.1 | 0.01 | |
RCT | 2 | 0.98 | 0.62-1.54 | 0.929 | 0 | 0.62 | |
4Y | Retrospective | 5 | 0.77 | 0.46-1.29 | 0.323 | 60.8 | 0.04 |
5Y | Prospective | 2 | 1.49 | 0.31-7.22 | 0.620 | 71.2 | 0.06 |
Retrospective | 5 | 0.86 | 0.62-1.19 | 0.357 | 34.8 | 0.19 | |
RCT | 2 | 0.79 | 0.50-1.15 | 0.197 | 0 | 0.76 | |
Unspecified | Retrospective | 4 | 1.54 | 1.15-2.05 | 0.004 | 0 | 0.50 |
RCT | 2 | 1.47 | 0.73-2.96 | 0.282 | 0 | 0.50 | |
Local recurrence rate – OR | |||||||
1Y | Retrospective | 4 | 0.78 | 0.29-2.11 | 0.619 | 62.8 | 0.04 |
RCT | 3 | 1.09 | 0.39-3.05 | 0.872 | 0 | 0.40 | |
2Y | Retrospective | 4 | 1.00 | 0.40-2.45 | 0.992 | 76.2 | 0.06 |
RCT | 2 | 1.02 | 0.23-4.58 | 0.975 | 70.4 | 0.07 | |
3Y | Retrospective | 2 | 0.80 | 0.11-5.97 | 0.826 | 84.8 | 0.01 |
RCT | 1 | 0.73 | 0.30-1.8 | 0.493 | - | - | |
4Y | Retrospective | 2 | 2.14 | 1.12-4.07 | 0.021 | 0 | 0.86 |
5Y | Prospective | 1 | 2.22 | 0.49-10.02 | 0.301 | - | - |
RCT | 1 | 0.52 | 0.30-0.91 | 0.023 | - | - | |
Unspecified | Prospective | 3 | 0.60 | 0.25-1.39 | 0.233 | 0 | 0.44 |
Retrospective | 20 | 0.67 | 0.51-0.87 | 0.002 | 37.2 | 0.05 | |
1 | 0.26 | 0.06-1.07 | 0.063 | - | - |
Table 3 Summary of the comparison of median and mean overall survival rates between microwave ablation versus radiofrequency ablation for intrahepatic hepatocellular carcinoma lesions in both cohort studies and randomised controlled trials
Year | MWA sample size | RFA sample size | Median OS | P value | |
MWA | RFA | ||||
1 | 1135 | 1623 | 96.2% | 95.4% | 0.31 |
2 | 651 | 789 | 90.7% | 88.0% | 0.10 |
3 | 1004 | 1480 | 80.5% | 75.3% | 0.002 |
4 | 421 | 464 | 76.8% | 70.0% | 0.02 |
5 | 764 | 1221 | 67.3% | 69.5% | 0.30 |
Table 4 Summary of overall survival and local recurrence rate HRs
Endpoint | Study design | No. of studies | HR | 95%CI | P for significance | I2 | P for heterogeneity |
Overall survival – HR | |||||||
Univariate | Retrospective | 2 | 1.17 | 0.75-1.83 | 0.497 | 17.5 | 0.27 |
Multivariate | Retrospective | 3 | 1.32 | 0.92-1.89 | 0.130 | 0.8 | 0.36 |
Unspecified | Prospective | 1 | 1.45 | 0.96-2.19 | 0.078 | - | - |
Retrospective | 13 | 1.06 | 0.86-1.32 | 0.580 | 58.6 | 0.004 | |
RCT | 4 | 1.34 | 0.97-1.86 | 0.079 | 0 | 0.58 | |
Local recurrence rate – HR | |||||||
Univariate | Retrospective | 3 | 1.77 | 0.81-3.88 | 0.151 | 63.9 | 0.06 |
Multivariate | Retrospective | 2 | 1.88 | 0.79-4.47 | 0.151 | 56.1 | 0.13 |
Cox proportional | Retrospective | 1 | 2.17 | 1.04-4.50 | 0.040 | - | - |
Fine and gray | Retrospective | 1 | 2.07 | 0.95-4.26 | 0.070 | - | - |
Unspecified | Retrospective | 1 | 2.00 | 0.50-8.00 | 0.326 | - | - |
Table 5 Microwave ablation versus radiofrequency ablation for hepatocellular lesions: Meta-analysis of adverse events
Adverse event | No. of studies | OR | 95%CI | P for significance | I2 | P for heterogeneity | |
Liver-related morbidity | 11 | 1.51 | 0.64-3.55 | 0.342 | 0 | 0.91 | |
Postprocedural infections | 19 | 1.3 | 0.85-1.97 | 0.222 | 0 | 0.83 | |
Postprocedural bleeding | 10 | 2.36 | 0.92-6.07 | 0.075 | 0 | 0.97 | |
Bile duct injury | 5 | 1.88 | 0.57-6.23 | 0.299 | 0 | 0.99 | |
Respiratory events | 14 | 1.99 | 1.07-3.71 | 0.03 | 0 | 0.87 | |
Local events | 4 | 1.62 | 0.49-5.36 | 0.426 | 0 | 0.57 |
- Citation: Tang MJ, Eslick GD, Lubel JS, Majeed A, Majumdar A, Kemp W, Roberts SK. Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis. World J Meta-Anal 2022; 10(4): 220-237
- URL: https://www.wjgnet.com/2308-3840/full/v10/i4/220.htm
- DOI: https://dx.doi.org/10.13105/wjma.v10.i4.220