Radiofrequency ablation combined with systemic therapy versus systemic therapy alone for unresectable colorectal liver metastases: a systematic review and meta-analysis.

BACKGROUND: Colorectal cancer liver metastases (CRLM) remain a major therapeutic challenge with limited curative options. Radiofrequency ablation (RFA) has emerged as a potential adjunct to systemic therapy, but its survival benefit remains uncertain. METHODS: This systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, the Cochrane Library, ScienceDirect, and Embase were searched through 16 June 2025. Data were analyzed using RevMan version 5.4. Hazard ratios (HRs) were pooled for overall survival (OS) and progression-free survival (PFS), and risk ratios (RRs) were calculated for binary outcomes, each with 95% confidence intervals (CIs). Risk of bias was assessed using RoB 2 and ROBINS-I. RESULTS: Out of 4625 records screened, three studies comprising 614 patients met the inclusion criteria. Pooled analysis demonstrated that RFA combined with systemic therapy significantly improved OS (HR = 0.46, 95% CI: 0.36-0.60, P < 0.001) and PFS (HR = 0.37, 95% CI: 0.20-0.67, P < 0.001) compared with systemic therapy alone. Secondary endpoints showed lower mortality (RR = 0.67, 95% CI: 0.59-0.76, P < 0.001) and reduced disease progression (RR = 0.92, 95% CI: 0.87-0.98, P = 0.005) in the RFA group. CONCLUSIONS: RFA combined with systemic therapy is associated with improved OS and PFS, with a trend toward reduced mortality and disease progression compared with systemic therapy alone among patients with unresectable colorectal liver metastases. These findings suggest a potential role for RFA in multimodal treatment; however, they should be interpreted cautiously given the limited and heterogeneous evidence base.