Navigating the evidence for hepatocellular carcinoma treatment: Surgery vs radiofrequency ablation through sentiment and meta-analysis

BACKGROUND Hepatocellular carcinoma (HCC) is among the most aggressive primary liver cancers, leading to significant global mortality. While early diagnosis improves prognosis, treatment decisions, particularly between surgical resection and radiofrequency ablation (RFA), remain controversial. AIM To clarify this issue using sentiment analysis of medical literature alongside a meta-analysis of overall survival (OS). METHODS We included studies comparing liver resection and RFA, excluding case reports, editorials, and studies without relevant outcomes. A systematic search in PubMed and Web of Science identified 197 studies. Abstracts underwent sentiment analysis using Python's Natural Language Toolkit library, categorizing them as favoring resection, ablation, or neutral. We also performed a meta-analysis using a random-effects model on 11 studies reporting hazard ratios (HRs) for OS. RESULTS Sentiment analysis revealed that 75.1% of abstracts were neutral, 14.2% favored resection, and 10.7% favored RFA. The meta-analysis showed a significant survival advantage for liver resection, with a pooled HR of 0.5924 (95% confidence interval: 0.540-0.649). Heterogeneity was moderate (I-2 = 39.98%). Despite the meta-analysis demonstrating clear survival benefits of liver resection, most abstracts maintained a neutral stance. This discrepancy highlights potential biases or hesitancy in drawing definitive conclusions. CONCLUSION The study emphasizes the need for clinicians to prioritize robust statistical evidence over narrative impressions. Liver resection remains the preferred treatment for HCC in eligible patients.