Background: The systematic reviews (SRs) of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC) are increasing, however, qualities of them varies.
Objectives: This study was supported by Ministry of Science and Technology of China to evaluate the quality and their impacts on outcomes.
Methods: We searched six databases and five official websites, and the Overview Quality Assessment Questionnaire (OQAQ), the Cochrane Collaboration’s tool, and modified MINORS score were applied to assess their quality for SRs, randomized (RCTs) and non-randomized controlled trials (NRCTs), respectively. Pooled odds ratio (OR) and 95% confidence intervals (CI) were integrated by Stata 10.0 software.
Results: Nineteen SRs were included. The overall quality was poor, with a mean OQAQ score of 3.3(95% CI, 2.6–4.1). Only five (26.3%) SRs were assessed as good quality. Six (31.6%) misused statistical models, and three of them changed outcome direction after modification. The authors of five SRs included retrospective studies as RCT. A total of 39 primary studies referenced by SRs were included. Three RCTs were leveled grade B, and 35 NRCTs were of moderate quality, with an estimated mean MINORS score of 15.0 (95% CI, 14.6–15.4). Certain studies (17/39, 43.6%) did not meet inclusion criteria for the SRs; and nine were mixed with other effective interventions in both groups. Four studies included patients with non-primary HCC.
Conclusions: The overall quality of SRs comparing the effects between RFA and HR for early HCC is poor. There is high heterogeneity and low evidence level. Physicians should take caution when applying the results of these studies to their clinical practice.