Microwave ablation versus other interventions for hepatocellular carcinoma: A systematic review and meta-analysis

We aim to evaluate the efficacy and safety of microwave ablation (MWA) versus other treatment modalities for hepatocellular carcinoma (HCC). This study was registered in Prospero (registration number CRD42017057046). A complete electronic search was conducted for studies on MWA versus other interventions for HCC using PubMed, EMBASE, Cochrane Library databases, and ISI Web of Science. Randomized and non-randomized clinical trials were included. Data on technical efficacy, local tumor progression (LTP), overall survival (OS), progression-free survival (PFS), and major complications were extracted from included studies and combined to be analyzed via random effects models. OS was set as the primary outcome measure. Fifteen clinical studies were identified. When comparing MWA with radiofrequency ablation (RFA), no significant difference was found in 3-year OS rates (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.66-1.34, P = 0.74), 5-year OS rates (OR 0.83, 95% CI 0.58-1.18, P = 0.29), 3-year PFS rates (OR 1.05, 95% CI 0.77-1.43, P = 0.74), 1-year LTP rate (OR 1.28, 95% CI 0.52-3.18,P = 0.59), technical efficacy rate (OR 1. 35, 95% CI 0. 85-2.15, P = 0.20), and major complication rate (OR 1.04, 95% CI 0.56-1.93, P = 0.90). When comparing MWA with hepatic resection, the 3-year OS rate was not significantly different (OR 0.89, 95% CI 0.59-1.35, P = 0.59). Compared with RFA and hepatic resection, MWA showed similar safety and efficacy for HCC, especially in OS rate and PFS. However, high-quality clinical trials are needed to validate the superiority of MWA.