A Systematic Assessment of the Quality of Systematic Reviews/Meta-Analyses in Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinoma<sup>△</sup>_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGYing-qiang ^1,2 , LUOQian-qian ³ ,  LIYou-ping ¹ , DENGShao-lin ^4,5 , LIXiang-lian ¹ , WEIShi-you ⁴

1. Chinese Evidence-Based Centre, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Department of Medical Administration, 363^th Hospital, Chengdu 610041, China;
3. National Center for Safety Evaluation of Drugs(Chengdu), West China Hospital, Chengdu 610041, China;
4. West China Medical School, West China Hospital, Sichuan University, Chengdu 610041, China;
5. West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding?author：

LIYou-ping, Email: yzmylab@hotmail.com

Keywords：

Radiofrequency ablation; Hepatic resection; Hepatocellular carcinoma; Quality assessment; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20140095

Video：

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Objective To evaluate the methodological quality and impacts on outcomes for systematic reviews (SRs) of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC). Methods We comprehensively searched six databases and five official websites for health technology assessment (HTA), to collect HTAs, SRs, or meta-analyses from inception to Nov. 11^th, 2012. The Overview Quality Assessment Questionnaire (OQAQ) was applied for quality assessment of included studies, the tools recommended by the Cochrane Collaboration was applied for quality assessment for randomized controlled trials (RCTs), and the modified MINORS score was applied to assess non-randomized controlled trials (NRCTs). The odds ratios (ORs) and 95% confidence intervals (CIs) were integrated using Stata 10.0 software. Results One HTA, 3 SRs and 15 meta-analyses were included in total. The mean OQAQ score was 3.3 with 95%CI 2.6 to 4.1. Only five (26.3%) SRs were assessed as good quality. Seven studies misused statistical models, and 3 of them changed outcome direction after modification. Five studies (5/19) included retrospective controlled studies as RCTs. A total of 39 primary studies referenced by SRs were included, of which, 3 RCTs were levelled grade B, 35 NRCTs were of moderate quality, with an estimated mean MINORS score of 15.0 (totally, scored 18) with 95%CI 14.6 to 15.4, and only 13 studies (37.1%) scored more than 16. Seventeen primary studies (43.6%) did not meet inclusion criteria of the SRs, of which, 9 (23.1%) studies were mixed with other effective interventions in both groups (TACE, PEI, etc.). Four studies included patients with non-primary HCC. Conclusion Currently, the overall quality of HTAs, SRs and meta-analyses about comparing the effects between RFA and HR for early HCC is fairly poor (high heterogeneity exists, and the evidence level is low. Physicians should apply the evidence with caution in clinical practice.

Citation： WANGYing-qiang, LUOQian-qian, LIYou-ping, DENGShao-lin, LIXiang-lian, WEIShi-you. A Systematic Assessment of the Quality of Systematic Reviews/Meta-Analyses in Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinoma^△. Chinese Journal of Evidence-Based Medicine, 2014, 14(5): 561-574. doi: 10.7507/1672-2531.20140095 Copy

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5. Bruix J, Sherman M. Management of hepatocellular carcinoma:an update. Hepatology, 2011, 53(3):1020-1022.
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8. Crocetti L, de Baere T, Lencioni R. Quality Improvement Guidelines for Radiofrequency Ablation of Liver Tumours. Cardiovasc Intervent Radiol, 2010, 33(1):11-17.
9. Guglielmi A, Ruzzenente A, Valdegamberi A, et al. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. J Gastrointest Surg, 2008, 12(1):192-198.
10. Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol, 2012, 57(4):794-802.
11. Wang JH, Wang CC, Hung CH, et al. Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. J Hepatol, 2012, 56(2):412-418.
12. Peng ZW, Lin XJ, Zhang YJ, et al. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2cm or smaller:a retrospective comparative study. Radiology, 2012, 262(3):1022-1033.
13. Xu G, Qi FZ, Zhang JH, et al. Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma. World J Surg Oncol, 2012, 10(1):163.
14. Liu Z, Zhou Y, Zhang P, et al. Meta-analysis of the therapeutic effect of hepatectomy versus radiofrequency ablation for the treatment of hepatocellular carcinoma (Structured abstract). Surg Laparosc Endosc Percutan Tech, 2010(3):130-140.
15. Liu JG, Wang YJ, Du Z. Radiofrequency ablation in the treatment of small hepatocellular carcinoma:a meta analysis. World J Gastroenterol, 2010, 16(27):3450-3456.
16. 孫彪, 鄭傳勝, 馮敢生, 等.射頻消融對比手術切除治療小肝癌的Meta分析.世界華人消化雜志, 2011, 19(31):3255-3263.
17. Li L, Zhang JL, Liu XH, et al. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: A meta-analysis. J Gastroenterol Hepatol, 2012, 27(1):51-58.
18. Xie XQ, Dendukuri N, McGregor M. Percutaneous radiofrequency ablation for the treatment of early stage hepatocellular carcinoma: A health technology assessment. Int J Technol Assess Health Care, 2010, 26(4):390-397.
19. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. PLoS Med, 2009, 6(7):e1000097.
20. Oxman AD, Guyatt GH, Singer J, et al. Agreement among reviewers of review articles. J Clin Epidemiol, 1991, 44(1):91-98.
21. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44(11):1271-1278.
22. Slim K, Nini E, Forestier D, et al. Methodological index for nonrandomized studies (minors):development and validation of a new instrument. ANZ J Surg, 2003, 73(9):712-716.
23. Higgins JP, Green S. Conchrane Handbook for Systematic Reviews of Interventions 5.1.0[updated March 2011]. The Cochrane Collaboration2011.
24. Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg, 2011, 98(9):1210-1224.
25. Minami Y, Kudo M. Radiofrequency ablation of hepatocellular carcinoma:a literature review. Int J Hepatol, 2011, 2011:104685.
26. Lau WY, Lai EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma:a systematic review. Ann Surg, 2009, 249(1):20-25.
27. 黃子明, 張洪義, 李志杰, 等.射頻消融與手術切除治療小肝癌的Meta分析.中國現代普通外科進展, 2012, 15(03):211-215.
28. 游偉, 李相成.小肝癌射頻消融與手術切除療效的Meta分析.南京醫科大學學報(自然科學版), 2012, 32(08):1179-1184.
29. 周大臣, 耿小平, 朱立新, 等.經皮射頻消融與肝切除治療小肝癌的療效比較meta分析.中華外科雜志, 2011, 49(12):1132-1136.
30. 王振, 錢葉本.小肝癌射頻消融術與手術切除術療效的Meta分析.肝膽外科雜志, 2011, 19(01):23-27.
31. Gravante G, Overton J, Sorge R, et al. Radiofrequency ablation versus resection for liver tumours:an evidence-based approach to retrospective comparative studies. J Gastrointest Surg, 2011, 15(2):378-387.
32. Zhou Y, Zhao Y, Li B, et al. Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterology, 2010, 10:78.
33. 師禮鵬, 王一.國內外肝癌射頻消融術與手術切除3年生存率Meta分析.齊魯醫學雜志, 2009, 24(05):413-415.
34. 杜娟, 邰沁文, 曹峻, 等.經皮熱消融與手術切除治療小肝癌療效比較的系統評價.中華現代外科學雜志, 2009, 6(10):605-609.
35. 陳汝福, 肖調華, 周泉波, 等.射頻消融治療肝硬化型小肝癌臨床效果的循證分析.中華外科雜志, 2008, 46(18):1413-1418.
36. Chagnon S. Prospective randomized trial of radiofrequency ablation versus surgical resection for small hepatocellular carcinomas. J Radiol, 2007, 88(12):1842-1844.
37. Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg, 2006, 243(3): 321-328.
38. Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg, 2010, 252(6):903-912.
39. 陳敏山, 李錦清, 梁惠宏, 等.經皮射頻消融與手術切除治療小肝癌的療效比較.中華醫學雜志, 2005, 85(2):80-83.
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Chinese Journal of Evidence-Based Medicine

A Systematic Assessment of the Quality of Systematic Reviews/Meta-Analyses in Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinoma^△

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A Systematic Assessment of the Quality of Systematic Reviews/Meta-Analyses in Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinoma△

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A Systematic Assessment of the Quality of Systematic Reviews/Meta-Analyses in Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinoma^△