Comparative effectiveness of advanced radiofrequency ablation electrode systems for hepatocellular carcinoma: A systematic review and network meta-analysis.

e16237 Background: Percutaneous radiofrequency ablation (RFA) offers a curative option for early-stage hepatocellular carcinoma (HCC) in nonsurgical candidates, but conventional techniques have higher local tumor progression (LTP) than resection due to inadequate margins and heat sink effects. Advanced electrode systems address these issues, yet comparative evidence is fragmented. This network meta-analysis synthesizes data to identify the optimal RFA electrode configuration for better HCC ablation outcomes. Methods: A total of 693 studies from PubMed, Embase, Scopus, and Cochrane were screened. RCTs and cohort studies of adults with HCC undergoing percutaneous RFA were included, comparing six electrode types: conventional single straight internally cooled monopolar (MonoRFA), internally cooled wet monopolar (ICW_MonoRFA), twin internally cooled wet bipolar/multi-electrode (TICW_RFA), separable clustered internally cooled switching monopolar/no-touch (SC_MonoRFA), expandable needle monopolar (Exp_MonoRFA), and no-touch multi-electrode RFA (NT-mbpRFA). Primary outcomes: CR and OS. Primary outcomes were complete remission (CR) and overall survival (OS). Frequentist network meta-analysis was performed in R (v4.5.2) using netmeta. Results: A total of 19 publications (28 direct comparisons, N = 2,421) evaluated six RFA electrode systems: MonoRFA (n = 1,041), SC_MonoRFA (n = 414), NT_mbpRFA (n = 463), ICW_MonoRFA (n = 218), Exp_MonoRFA (n = 243), and TICW_RFA (n = 42). SC MonoRFA has a significantly better OS compared to MonoRFA (OR: 0.48, p = 0.02). The LTP is significantly lower for SC monoRFA (OR: 0.33, p < 0.0001) and NT mbpRFA (OR: 0.34, p < 0.0001) compared to MonoRFA. Treatment effectiveness was worse for NT_mbpRFA versus MonoRFA (OR: 5.59, p = 0.03); however, it was highly confounded. There was no statistically significant difference for major complications and complete ablation rates. CR was highest for SC_MonoRFA (OR: 3.96, p < 0.01) and NT_mbpRFA (OR: 2.36, p > 0.05), although rates did not differ significantly from conventional MonoRFA. Cumulative ranking analysis (SUCRA/P-score) consistently positioned SC_MonoRFA as the top-ranked treatment for both LTP and OS, followed by NT_mbpRFA for LTP control. The network for the primary LTP outcome showed low statistical heterogeneity (I² = 0%) and no significant global inconsistency (p = 0.69), supporting the robustness of the comparative estimates. Conclusions: This network meta-analysis shows that separable clustered electrode RFA systems provide statistically superior local tumor control and OS in HCC versus conventional monopolar RFA, without increased major complications. Future research should focus on RCTs comparing it against other advanced systems in standardized populations, plus cost-effectiveness and implementation studies for global adoption.