Review for 10.1186/s12876-020-01544-0 (2020)

Reviewer’s report
Title: 
Radiofrequency ablation versus hepatic resection for recurrent
hepatocellular carcinoma: an updated meta-analysis
Version: 
1 
Date: 
01 Nov 2020
Reviewer's report:
Nov2, 2020
Dear Editors BMCG
Manuscript ID: BMGE-D-20-01219R1
MS. Title: Radiofrequency ablation versus hepatic resection for recurrent
hepatocellular
carcinoma: an updated meta-analysis
Authors: Xiaohua Xie, et al. 
1. Key finding s of this study were The meta-analysis showed that RHR had
superior OS (HR 0.77, 95% CI =0.65-0.92, P=0.004) and PFS (HR 0.81, 95% CI
=0.67-0.98, P=0.027) compared to RFA, whereas major complications may be
less frequent in the RFA group (OR 0.15, 95% CI = 0.06-0.39, P<0.001
2. Population: From 10 studies with 1612 patients (RHR = 654, RFA = 958)
were included in the meta- analysis. The majority of the sample population was
CP-A (98.3%) and CP-B accounted only 28 cases (1.7%).This selective group of
CP-A have effect on the outcome of overall survival esp. hepatic resection.
Previous article showed that Pre-op MELD had effects on the overall survival1.
The 1-, 3-, and 5-year tumor-free survival rates were 68.4%, 57.9%, and 57.9%,
respectively, for SLT; 69.7%, 49.3%, and 49.3%, respectively, for RR; and
40.0%, 19.8%, and 10.6%, respectively, for rRFA (P=0.001)
3. The total number of 1084 from 1612 cases (67%) caused by HBV infection
which may receive anti-viral agent and this treatment may effect on the overall
survival and outcome too. No details of this information and should add on in
the discussion part.
4. Intervention: The overall result of RFA versus RHR are clearly reported,
however the subgroup analysis which focused on the size of tumor < 3 cm and 3-
5 cm are limited due to the small sample size (2-3 studies) and the indication of
RFA use in HCC tumor size of 3-5 cm is not rational. Thus, the author should
explain the reason of using treatment choices. Additionally, HCC patients with
intrahepatic recurrent tumor should consider for liver transplantation, how many
of them had underwent for this procedure1.
5. Other confounders to the overall survival including the progression or
occurrence of cirrhosis, age group, maximal tumor size at recurrent time, the
duration of the procedure and the expertise of care team should be mentioned for
the outcome.2-7
References
1. Chan AC, Chan SC, Chok KS, et al. Treatment strategy for recurrent
hepatocellular carcinoma: salvage transplantation, repeated resection, or
radiofrequency ablation? Liver Transpl 2013;19:411-9.
2. Sun WC, Chen IS, Liang HL, et al. Comparison of repeated surgical resection
and radiofrequency ablation for small recurrent hepatocellular carcinoma after
primary resection. Oncotarget 2017;8:104571-104581.
3. Eisele RM, Chopra SS, Lock JF, et al. Treatment of recurrent hepatocellular
carcinoma confined to the liver with repeated resection and radiofrequency
ablation: a single center experience. Technol Health Care 2013;21:9-18.
4. Fujiwara N, Tateishi R, Kondo M, et al. Cause-specific mortality associated
with aging in patients with hepatocellular carcinoma undergoing percutaneous
radiofrequency ablation. Eur J Gastroenterol Hepatol 2014;26:1039-46.
5. Asaoka Y, Tateishi R, Nakagomi R, et al. Frequency of and predictive factors
for vascular invasion after radiofrequency ablation for hepatocellular carcinoma.
PLoS One 2014;9:e111662.
6. Tateishi R, Shiina S, Akahane M, et al. Frequency, risk factors and survival
associated with an intrasubsegmental recurrence after radiofrequency ablation
for hepatocellular carcinoma. PLoS One 2013;8:e59040.
7. Shiina S, Tateishi R, Arano T, et al. Radiofrequency ablation for
hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J
Gastroenterol 2012;107:569-77; quiz 578.
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