Liver transplantation versus liver resection for hepatocellular carcinoma in intention to treat: An attempt to perform an ideal meta‐analysis

Abstract

This meta-analysis compared the effects of liver transplantation (LT) and liver resection (LR) on overall survival (OS) and disease-free survival (DFS) in patients with hepatocellular carcinoma (HCC) small transplantable HCC or within Milan criteria. Articles comparing LR with LT for HCC, based on Milan criteria or small size, published up to June 2015 were selected, and a meta-analysis was performed. No randomized controlled trial has been published to date comparing survival outcomes in patients with HCC who underwent LR and LT. Nine studies were identified, including 570 patients who underwent LR and 861 who underwent LT. For HCC within the Milan criteria, the 1-year OS rates following LR and LT were 84.5% (473/560) and 84.4% (710/841), respectively (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.71-1.33; P = 0.8), and the 5-year OS rates were 47.9% (273/570) and 59.3% (509/858), respectively (OR, 0.60; 95% CI, 0.35-1.02; P = 0.06). One-year DFS rates were similar (OR, 1.00; 95% CI, 0.39-2.61; P = 1.00), whereas the 3-year DFS rate was significantly lower in the LR group (54.4%, 210/386) than in the LT group (74.2%, 317/427; OR, 0.24; 95% CI, 0.07-0.80; P = 0.02), and the 5-year DFS rate was significantly lower for LR than LT (OR, 0.18; 95% CI, 0.06-0.53; P < 0.01). For small HCCs, the 5-year OS rate was significantly lower for patients who underwent LR than LT (OR, 0.30; 95% CI, 0.19-0.48; P < 0.001). In conclusion, relative to LR, LT in patients with HCC meeting the Milan criteria had no benefits before 10 years for OS. For DFS, the benefit is obtained after 3 years. Liver Transplantation 23 836-844 2017 AASLD.

WITHDRAWN: Overexpression of miR-382 sensitizes hepatocellular carcinoma cells to γδ T cells through inhibiting the expression of c-FLIP

“…Surgery and liver transplantation treatment are the most effective treatment for early stage HCC patients [2,3]. However, many patients were diagnosed as advanced HCC at their first visit.…”

Engineered Anti‐GPC3 Immunotoxin, HN3‐ABD‐T20, Produces Regression in Mouse Liver Cancer Xenografts Through Prolonged Serum Retention

“…Unfortunately, treatment with these tyrosine kinase inhibitors provides only a 3‐month increase in survival . When liver cancer is identified in an early stage, tumor resection and liver transplantation offer the best 5‐year survival rates, at 47.9% and 59.3%, respectively . Sadly, most patients succumb to disease before a suitable donor can be found.…”

Recurrence beyond the Milan criteria after curative‐intent resection of hepatocellular carcinoma: A novel tumor‐burden based prediction model

“…4,5,24,25 Although transplantation is considered superior to resection for patients with compromised liver function and inadequate future liver remnant, 4 the two treatment when an intention-to-treat analysis is utilized. [25][26][27][28] Indeed, delaying a potentially curative liver resection increases the likelihood of disease progression and, thus, compromises patient outcomes. 5,29 Due to the scarcity of available organs, upfront liver resection is currently performed for the majority of patients presenting with resectable HCC.…”