Percutaneous radiofrequency ablation for the treatment of early stage hepatocellular carcinoma: A health technology assessment
Bibliographic record
Abstract
OBJECTIVES: The aim of this study was to compare the clinical effectiveness and cost of percutaneous radiofrequency ablation (PRFA) and surgical resection (SRS) for the management of early stage Hepatocellular Carcinoma. METHODS: A systematic literature search of articles in English, French, and Chinese was performed using online databases. Only articles with patients classified as Child-Pugh Class A or B, with tumor size <5 cm were included. A meta-analysis was carried out to estimate the survival rate and disease-free survival rate following PRFA or SRS treatments. The cost of each treatment was estimated from the third party perspective. Univariate sensitivity analyses were used to study the relative importance of each component cost. RESULTS: We identified six studies (one randomized controlled trial (RCT) and five comparative cohort studies) meeting our inclusion criteria. There is good evidence that among Child-Pugh A patients for whom both SRS and PRFA are available options, survival rates following either procedure are comparable, while complications are more frequent and hospitalization longer following SRS. The evidence concerning recurrence rates and disease-free survival is less clear. Whereas the RCT indicates comparable outcomes with either procedure up to 3 years, the results of five cohort studies (with possible selection bias), particularly those with a mix of Child-Pugh A and B patients, favor the surgical option. SRS, costs approximately Canadian $8,275 more per case than PRFA. CONCLUSIONS: Continuing doubts on this issue can only be resolved by a substantial RCT. Meanwhile, for early stage HCC patients classified as Child-Pugh A, who despite a possibly higher recurrence rate, prefer the less invasive PRFA to open surgery with its attendant risks, there is sufficient evidence to justify such a choice. For those classified as Child-Pugh (B) it is possible that overall survival is equally good with PRFA, but the evidence is less certain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.068 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.013 |
| Bibliometrics | 0.015 | 0.010 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".