***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND To compare the results of radiofrequency ablation ( RFA ) with hepatic resection in the treatment of hepatocellular carcinoma ( HCC ) within the Milan criteria . METHODS A nonr and omized comparative study was performed with 111 consecutive patients who underwent laparoscopic RFA ( n = 31 ) or curative hepatic resection ( n = 80 ) for HCC within Milan criteria . RESULTS Procedure related complications were less often and severe after RFA than resection ( 3.2 % vs. 25 % ) . There was no significant difference in hospital mortality ( 0 % vs. 3.8 % ) . Hospital stay was significantly shorter in the RFA group than in the resection group ( mean , 3.8 vs. 6.8 days ) . The 1- , 3- , and 5-year disease-free survival rates for the RFA group and the resection group were 76 % , 40 % , 40 % and 76 % , 60 % , 60 % , respectively . Disease-free survival was significantly lower in the RFA group than in the resection group . The corresponding 1- , 3- , and 5-year overall survival rates for the RFA group and the resection group were 100 % , 92 % , 84 % , and 92 % , 75 % , 71 % , respectively . The overall survival for RFA and resection were not significantly different . CONCLUSIONS Our result showed comparable overall survival between RFA and surgery , although RFA was associated with a significantly higher tumor recurrence rate .  RFA had the advantages over surgical resection in being less invasive and having lower morbidity Abstract Background Hepatocellular carcinoma ( HCC ) is a primary tumor of the liver with poor prognosis . For early stage HCC , treatment options include surgical resection , liver transplantation , and percutaneous ablation . Percutaneous ablative techniques ( radiofrequency and microwave techniques ) emerged as best therapeutic options for nonsurgical patients . Aims We aim ed to determine the safety and efficacy of radiofrequency and microwave procedures for ablation of early stage HCC lesions and prospect ively follow up our patients for survival analysis . Patients and methods One Hundred and 11 patients with early HCC are managed in our multidisciplinary clinic using either radiofrequency or microwave ablation . Patients are assessed for efficacy and safety . Complete ablation rate , local recurrence , and overall survival analysis are compared between both procedures . Results Radiofrequency ablation group ( n = 45 ) and microwave ablation group ( n = 66 ) were nearly comparable as regards the tumor and patients characteristics . Complete ablation was achieved in 94.2 and 96.1 % of patients managed by radiofrequency and microwave ablation techniques , respectively ( p value 0.6 ) with a low rate of minor complications ( 11.1 and 3.2 , respectively ) including subcapsular hematoma , thigh burn , abdominal wall skin burn , and pleural effusion . Ablation rates did not differ between ablated lesions ≤3 and 3–5 cm . A lower incidence of local recurrence was observed in microwave group ( 3.9 vs. 13.5 % in radiofrequency group , p value 0.04 ) . No difference between both groups as regards de novo lesions , portal vein thrombosis , and abdominal lymphadenopathy . The overall actuarial probability of survival was 91.6 % at 1 year and 86.1 % at 2 years with a higher survival rates noticed in microwave group but still without significant difference ( p value 0.49 ) . Conclusion Radiofrequency and microwave ablations led to safe and equivalent ablation and survival rates ( with superiority for microwave ablation as regards the incidence of local recurrence ) Background R and omized trials suggest that radiofrequency ablation ( RFA ) may be more effective than percutaneous ethanol injection ( PEI ) in the treatment of hepatocellular carcinoma ( HCC ) . However , the survival advantage of RFA needs confirmation in daily practice . Methods We conducted a population -based cohort study using the Taiwan Cancer Registry , National Health Insurance cl aim data base and National Death Registry data from 2004 through 2009 . Patients receiving PEI or RFA as first-line treatment for newly-diagnosed stage I-II HCC were enrolled . Results A total of 658 patients receiving RFA and 378 patients receiving PEI treatment were included for final analysis . The overall survival ( OS ) rates of patients in the RFA and PEI groups at 5-year were 55 % and 42 % , respectively ( p < 0.01 ) . Compared to patients that received PEI , those that received RFA had lower risks of overall mortality and first-line treatment failure ( FTF ) , with adjusted hazard ratios ( HRs ) [ 95 % confidence interval ( CI ) ] of 0.60 ( 0.50 - 0.73 ) for OS and 0.54 ( 0.46 - 0.64 ) for FTF . The favorable outcomes for the RFA group were consistently significant for patients with tumors > 2 cm as well as for those with tumors < 2 cm . Consistent results were also observed in other subgroup analyses defined by gender , age , tumor stage , and co-morbidity status . Conclusion RFA provides better survival benefits  than PEI for patients with unresectable stage I-II HCC , irrespective of tumors > 2 cm or ≤ 2 cm , in contemporary clinical practice Evidence of relative effectiveness of local treatments for hepatocellular carcinoma ( HCC ) is scanty . We investigated , in a retrospective cohort study , whether surgical resection , radiofrequency ablation ( RFA ) , percutaneous ethanol injection ( PEI ) , and transarterial embolization with ( TACE ) or without ( TAE ) chemotherapy result ed in different survival in clinical practice . All patients first diagnosed with HCC and treated with any locoregional therapy from 1998 to 2002 in twelve Italian hospitals were eligible .  Overall survival ( OS ) was the unique endpoint . Three main comparisons were planned : RFA versus PEI , surgical resection versus RFA/PEI ( combined ) , TACE/TAE versus RFA/PEI ( combined ) . Propensity score method was used to minimize bias related to non r and om treatment assignment . Overall 425 subjects were analyzed , with 385 ( 91 % ) deaths after a median followup of 7.7 years . OS did not significantly differ between RFA and PEI ( HR 1.11 , 95 % CI 0.79 - 1.57 ) , between surgery and RFA/PEI ( HR 0.95 , 95 % CI 0.64 - 1.41 ) and between TACE/TAE and RFA/PEI ( HR 0.88 , 95 % CI 0.66 - 1.17 ) . 5-year OS probabilities were 0.14 for RFA , 0.18 for PEI , 0.27 for surgery , and 0.15 for TACE/TAE . No locoregional treatment for HCC was found to be more effective than the comparator . Adequately powered r and omized clinical trials are still needed to definitely assess relative effectiveness of locoregional HCC treatment BACKGROUND AND STUDY AIMS Hepatocellular carcinoma ( HCC ) is a major burden on health-care systems worldwide . Although radiofrequency ablation ( RFA ) is currently considered the best technique for coagulative necrosis , the superiority of concomitant use of RFA and percutaneous ethanol injection ( PEI ) needs to be determined . The study was design ed to compare efficacy , safety and rate of survival of patients with HCC assigned to receive combined PEI-RFA versus RFA alone and versus PEI alone . PATIENTS AND METHODS This 3-year study enrolled 90 cirrhotic patients with HCC ( Child 's class A or B , but not class C ) . They were r and omly assigned for either PEI-RFA ( group I ) , RFA alone ( group II ) or PEI alone ( group III ) . The primary end point was ablation of the tumour . The secondary end point was rate of survival and recurrence . RESULTS After the first session , complete ablation was significantly higher in the combination group ( 87.9 % ) compared with the RFA group ( 54.54 % ) . After the second session , complete ablation was achieved in 97.0 % of the combination group and in 84.8 % of the RFA group . Regarding the PEI group , 75 % had complete ablation , whereas 25 % had partial ablation after multiple sessions . The survival rate , 1.5 years later , was significantly higher in group I ( 86.7 % ) compared with group III ( 63.3 % ) . The overall incidence of serious adverse events was nil . CONCLUSION Combined treatment is superior to RFA alone and to PEI alone , in safety and efficacy in patients with HCC Purpose Although there are several prospect i ve clinical studies comparing radiofrequency ablation ( RFA ) and hepatic resection ( HR ) for the treatment of hepatocellular carcinoma , there are few trials that have been performed in strictly homogeneous patients . Methods Patients who were newly diagnosed with a solitary hepatocellular carcinoma were r and omized to the HR or RFA group . Inclusion criteria were as follows : age ≥ 20 years but ≤ 70 years , Child-Pugh class A , maximal diameter of the tumor ≥ 2 cm but ≤ 4 cm , no previous treatment history , and platelet count > 80,000/mm3 . Results Although the study was early terminated , 29 and 34 patients were enrolled in the  HR and RFA groups , respectively , and prospect ively followed on an intention-to-treat basis . The 5-year overall survival rates were 83.4 % and 86.2 % in the HR and RFA groups , respectively , which were not significantly different ( P = 0.812 by log-rank , P = 0.990 by Breslow ) . The 3- and 5-year disease-free survival rates in the HR group were significantly superior to those in the RFA group ( 66.7 % , 44.4 % vs. 44.1 % , 31.2 % , P = 0.071 by log-rank , P = 0.023 by Breslow ) . Intrahepatic local recurrence tended to develop more frequently in the RFA group ( P = 0.042 ) , while the frequency of intrahepatic distant and extrahepatic recurrence was similar bet ween the 2 groups . There were no significant differences in the frequency and severity of complications between the 2 groups . Conclusion HR was significantly superior to RFA in terms of disease-free survival ; however , the overall survival was excellent in both groups Objective : To compare the results of percutaneous local ablative therapy ( PLAT ) with surgical resection in the treatment of solitary and small hepatocellular carcinoma ( HCC ) . Summary Background Data : PLAT is effective in small HCC . Whether it is as effective as surgical resection in the long-term survivals remains unknown . Methods : We conducted a prospect i ve r and omized trial on 180 patients with a solitary HCC ≦5 cm to receive either PLAT or surgical resection .  The patients were regularly followed up after treatment with physical examination , blood , and radiologic tests . Results : Of the 90 patients who were r and omized to PLAT , only 71 received PLAT because 19 withdrew their consent . Of the 90 patients who were r and omized to surgical resection , a single Couinaud liver segment resection was carried out in 69 patients , 2 segments in 16 patients , and 3 or more segments in 3 patients . Ethanol injection was given during open surgery in 2 patients . Only 1 patient died after surgical resection within the same hospital admission . Posttreatment complications were more often and severe after surgery than PLAT . The 1- , 2- , 3- , and 4-year overall survival rates  after PLAT and surgery were 95.8 % , 82.1 % , 71.4 % , 67.9 % and 93.3 % , 82.3 % , 73.4 % , 64.0 % , respectively . The corresponding disease-free survival rates were 85.9 % , 69.3 % , 64.1 % , 46.4 % and 86.6 % , 76.8 % , 69 % , 51.6 % , respectively . Statistically , there was no difference between these 2 treatments . Conclusion : PLAT was as effective as surgical resection in the treatment of solitary and small HCC . PLAT had the advantage over surgical resection in being less invasive The effect of percutaneous microwave ablation and laparoscopic resection on the prognosis of liver cancer  was investigated . Ninety patients with liver cancer treated at our hospital from March 2010 to March 2012 were divided into group A and group B ( n=45 ) by using a r and om number table , and the surgical conditions and the prognosis were compared . The surgical conditions of patients in group A were significantly better than those in group B ( P<0.05 ) . The incidence of complications in group A was 6.67 % , which was obviously lower than that of group B ( P<0.05 ) . The local recurrence rate of group A was 20.00 % , and that of group B was 8.89 % , which showed a significant difference ( P<0.05 ) . The two groups did not differ significantly in terms of either total recurrence rate ( P>0.05 ) or 1-year , 2-year and 3-year survival ( P>0.05 ) . Both 
    Output:
    
There was little evidence of inconsistency between direct and indirect evidence .
Conclusion The comparison of different treatment strategies for HCC indicated that RES is associated with longer survival .