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Abstract

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the second leading cause of cancer-related mortality worldwide. Liver transplantation is considered the definitive treatment for HCC; however, in Indonesia, adult liver transplantation is still rarely performed due to donor limitations and high costs. Radiofrequency ablation (RFA) has therefore become a preferred therapeutic option in the management of HCC. This report discuss about the survival and recurrence rates of HCC in patients treated with RFA compared with those undergoing liver transplantation. A literature search was conducted using the PubMed, Cochrane, Embase, and Scopus databases. Selected articles were screened according to the predefined clinical question as well as inclusion and exclusion criteria. Critical appraisal was performed based on the 2011 Oxford Centre for Evidence-Based Medicine framework, assessing validity, importance, and applicability. Critical appraisal was conducted on two selected articles. One study reported comparable survival rates between the two groups. However, overall, both articles demonstrated that liver transplantation was associated with higher survival rates and lower recurrence rates compared with RFA. In conclusion, survival outcomes are superior with liver transplantation compared with RFA. Nevertheless, RFA may be considered in the management of hepatocellular carcinoma as a bridging therapy to liver transplantation or in situations where liver transplantation is not available.

Bahasa Abstract

Karsinoma hepatoseluler (hepatocellular carcinoma/HCC) merupakan jenis kanker yang paling sering terjadi dan menyebabkan kematian kedua tertinggi secara global. Transplantasi hati menjadi pengobatan definitif untuk karsinoma hepatoseluler, akan tetapi di Indonesia transplantasi hati pada dewasa belum banyak dilakukan karena keterbatasan donor dan tingginya biaya. Ablasi radiofrekuensi atau radiofrequency ablation (RFA) menjadi terapi pilihan untuk tata laksana HCC. Laporan ini membahas mengenai tingkat kesintasan dan rekurensi HCC pada pasien yang diterapi dengan RFA dibandingkan dengan transplantasi hati. Penelusuran literatur dilakukan melalui database Pubmed, Cochrane, Embase, dan Scopus. Artikel terpilih kemudian disesuaikan dengan pertanyaan klinis yang memenuhi kriteria inklusi dan eksklusi yang sudah ditentukan. Telaah kritis dilakukan sesuai dengan Oxford Center of Evidenced-Based Medicine tahun 2011 berdasarkan komponen validitas, kepentingan, dan kemampuan terapan. Telaah kritis dilakukan pada 2 artikel terpilih. Salah satu artikel memberikan angka kesintasan yang seimbang antara kedua kelompok. Namun secara keseleluruhan, kedua artikel melaporkan bahwa transplantasi hati memberikan angka kesintasan yang lebih tinggi dan rekurensi yang lebih rendah dari RFA. Sebagai kesimpulan, kesintasan dengan transplantasi hati lebih tinggi dibandingkan RFA. Akan tetapi, terapi RFA dapat dipertimbangkan dalam tata laksana karsinoma hepatoseluler sebagai penghubung menuju transplantasi hati atau bila transplantasi hati tidak tersedia.

Kata Kunci: HCC, kesintasan, RFA, transplantasi hati

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