Transarterial chemoembolization combined with radiofrequency ablation versus hepatectomy for hepatocellular carcinoma within the Milan criteria: a systematic review and meta-analysis.

Authors

Wenwu Wan, Hao Zhang, Li Zhang, Ding Xiong

Published in

European journal of gastroenterology & hepatology. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

Hepatocellular carcinoma (HCC) meeting the Milan criteria (single lesion ≤5 cm or ≤3 lesions each ≤3 cm) is most commonly treated with surgical resection, the current gold standard for curative treatment. However, surgical resection is often limited by poor hepatic reserve, unfavorable tumor location, or patient comorbidities, while the minimally invasive strategy combining transarterial chemoembolization and radiofrequency ablation (TACE-RFA) has emerged as an alternative, with its efficacy and safety vs. surgical resection remaining controversial. This meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with a systematic search of PubMed, Embase, Cochrane Library, Web of Science, and MEDLINE from database inception to 24 October 2025. We included comparative randomized controlled trials and retrospective studies reporting overall survival (OS), disease-free survival (DFS), or severe complications (Clavien-Dindo grade ≥III), with bias risk assessed via RoB 2 and ROBINS-I tools. A total of 12 studies enrolling 1625 patients (797 in the TACE-RFA group, 828 in the surgical resection group) were included. Pooled analysis showed surgical resection provided significantly better OS [hazard ratio = 1.17, 95% confidence interval (CI): 1.05-1.30, P = 0.003], with no significant DFS difference between groups (hazard ratio = 1.05, 95% CI: 0.89-1.23, P = 0.55). TACE-RFA was associated with markedly fewer severe complications (odds ratios = 0.24, 95% CI: 0.14-0.39, P < 0.00001). Subgroup analyses revealed surgical resection yielded significant OS benefits in 3-5 cm tumors, primary HCC, and high-quality studies, while TACE-RFA achieved comparable OS for tumors 3 cm or less or recurrent HCC. In conclusion, for Milan criteria HCC, surgical resection improves long-term survival, especially for primary and 3-5 cm tumors, while TACE-RFA has a superior safety profile with comparable tumor control for smaller/recurrent lesions, optimal for high surgical risk patients. Treatment should be individualized.

PMID:
42765294
Bibliographic data and abstract were imported from PubMed on 21 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.