Liver transplantation versus liver resection for hepatocellular carcinoma:a meta-analysis

Background Liver transplantation (LT) and liver resection (LR) are currently considered the standard treatment of patients with hepatocellular carcinoma (HCC). However, the outcomes of LT and LR are still inconclusive. Data sources MEDLINE, EMBASE, and Cochrane Library were searched for relevant stu...

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Published in:Hepatobiliary & pancreatic diseases international 2014-06, Vol.13 (3), p.234-241
Main Authors: Xu, Xin-Sen, Liu, Chang, Qu, Kai, Song, Yan-Zhou, Zhang, Peng, Zhang, Yue-Lang
Format: Article
Language:English
Subjects:
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - surgery
Disease Progression
Disease-Free Survival
Endocrinology & Metabolism
Gastroenterology and Hepatology
hepatectomy
Hepatectomy - adverse effects
Hepatectomy - mortality
hepatocellular carcinoma
Humans
Liver Neoplasms - mortality
Liver Neoplasms - pathology
Liver Neoplasms - surgery
liver transplantation
Liver Transplantation - adverse effects
Liver Transplantation - mortality
Neoplasm Recurrence, Local
Odds Ratio
Risk Factors
Time Factors
Treatment Outcome
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Summary:Background Liver transplantation (LT) and liver resection (LR) are currently considered the standard treatment of patients with hepatocellular carcinoma (HCC). However, the outcomes of LT and LR are still inconclusive. Data sources MEDLINE, EMBASE, and Cochrane Library were searched for relevant studies. Surgical safety indices such as treatment-related morbidity and mortality, and efficacy indices such as overall and tumor-free survival outcomes were evaluated. Weighted mean differences and odds ratios (ORs) were calculated using a random-effects model. Results Seventeen studies were included in this meta-analysis. LT achieved significantly higher rates of surgery-related morbidity (OR=1.47; 95% CI: 1.02-2.13) and mortality (OR=2.12; 95% CI: 1.11-4.05). Likewise, the 1-year survival rate was lower in LT (OR=0.86; 95% CI: 0.61-1.20). However, the 3- and 5-year survival rates were significantly higher in LT than in LR and the ORs were 1.12 (95% CI: 0.96-1.30) in 3 years and 1.84 (95% CI: 1.49-2.28) in 5 years. Furthermore, the tumor-free survival rate in LT was significantly higher than that in LR in 1, 3, 5 years after surgery, with the ORs of 1.72 (95% CI: 1.24-2.41), 3.75 (95% CI: 2.94-4.78) and 5.64 (95% CI: 4.35-7.31), respectively. Conclusions One-year morbidity and mortality are higher in LT than in LR for patients with HCC. However, long-term survival and tumor-free survival rates are higher in patients treated with LT than those treated with LR.
ISSN:1499-3872
DOI:10.1016/S1499-3872(14)60037-0