Summary of findings 1. Surgery versus radiofrequency ablation for people with early‐ or very early‐stage hepatocellular carcinoma.
| Surgery versus radiofrequency ablation for people with early‐ or very early‐stage hepatocellular carcinoma | |||||
|
Patient or population: people with early‐ or very early‐stage hepatocellular carcinoma eligible for surgery
Settings: secondary or tertiary care
Intervention: surgery Control: radiofrequency ablation | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Radiofrequency ablation | Surgery | ||||
|
All‐cause mortality at maximal follow‐up Follow‐up: 29 months to 42 months |
300 per 1000 | 248 per 1000 (193 to 320) | HR 0.80 (0.60 to 1.08) | 574 (4 trials) | ⊕⊝⊝⊝ very low1,2,3,4 |
|
Cancer‐related mortality at maximal follow‐up Follow‐up: 42 months |
374 per 1000 | 173 per 1000 (102 to 280) | OR 0.35 (0.19 to 0.65) | 230 (1 trial) | ⊕⊕⊝⊝ low1,2 |
|
Serious adverse events (number of participants) Follow‐up: postprocedural (very short term) |
17 per 1000 | 233 per 1000 (37 to 706) | OR 17.96 (2.28 to 141.6) | 120 (1 trial) | ⊕⊕⊝⊝ low1,2 |
|
Serious adverse events (number of events) Follow‐up: postprocedural (very short term) |
108 per 1000 | 758 per 1000 (247 to 2318) | Rate ratio 7.02 (2.29 to 21.46) | 391 (2 trials) | ⊕⊕⊝⊝ low1,2 |
| Health‐related quality of life | None of the trials reported this outcome. | ||||
| *The basis for the assumed risk for all‐cause mortality is the approximate control group proportions at two to three years reported in the Kaplan‐Meier curves in the trials that reported mortality at maximal‐follow‐up. We have assumed proportional hazards. The basis for the assumed risk for other outcomes is based on the mean control group proportion. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HR: hazard ratio; OR: odds ratio; RR: rate ratio | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1Downgraded one level because of within‐study risk of bias: there was unclear or high risk of bias in the trial(s). 2Downgraded one level because of imprecision: the sample size was small. 3Downgraded one level because of imprecision: the confidence intervals overlapped clinically significant effect and clinically insignificant effect. 4Downgraded one level because of inconsistency: there was substantial unexplained heterogeneity.