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Meta-Analysis
. 2017 Aug 7;114(31-32):519-526.
doi: 10.3238/arztebl.2017.0519.

Resection or Transplant in Early Hepatocellular Carcinoma

Markus B Schoenberg  1 , Julian N Bucher, Adrian Vater, Alexandr V Bazhin, Jingcheng Hao, Markus O Guba, Martin K Angele, Jens Werner, Markus Rentsch
Affiliations
Meta-Analysis

Resection or Transplant in Early Hepatocellular Carcinoma

Markus B Schoenberg et al. Dtsch Arztebl Int. .

Abstract

Background: Hepatocellular carcinoma (HCC) has an incidence of 5-10 per 100 000 persons per year in the Western world. In 20% of cases, surgical liver resection (LR) or liver transplantation (LT) can be performed. LT results in longer survival, as it involves resection not only of the tumor, but of pre - cancerous tissue as well. The optimal allocation of donor organs depends on the identification of patients for whom LR is adequate treatment. In this meta-analysis, we compare LT and LR for patients with early HCC and wellcompensated cirrhosis.

Methods: A systematic review of the pertinent literature was followed by a subgroup analysis of the studies in which patients with early HCC and wellcompensated cirrhosis were followed up after either LR or LT. Overall survival at 1, 3, and 5 years, as well as morbidity and mortality, were compared in a random effects meta-analysis.

Results: 54 studies with a total of 13 794 patients were included. Among patients with early HCC, the overall survival after LT became higher than the overall survival after LR 5 years after surgery (66.67% versus 60.35%, odds ratio 0.60 [0.45; 0.78], p <0.001); there was no significant difference 1 year or 3 years after surgery. Nor was there any significant difference in morbidity or mortality between the two types of treatment in this subgroup. These findings contrast with the results obtained in all of the studies, which documented significantly better survival 3 years after LT.

Conclusion: Three years after surgery, the survival rates and complication rates of patients with early HCC treated with either LR or LT are comparable. Resection should therefore be the preferred form of treatment if the prerequisites for it are met. In case of recurrent tumor, these patients can still be evaluated for liver transplantation. This strategy could improve the allocation of donor organs.

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Figures

Figure 1
Figure 1
Flow diagram of study selection
Figure 2
Figure 2
Forest plot of overall survival in patients with early hepatocellular carcinoma at 1-year follow-up CI: Confidence interval; M-H: Mantel-Haenszel test; random: Random effect
Figure 3
Figure 3
Forest plot of overall survival in patients with early hepatocellular carcinoma at 3-year follow-up CI: Confidence interval; M-H: Mantel-Haenszel test; random: Random effect
Figure 4
Figure 4
Forest plot of overall survival in patients with early hepatocellular carcinoma at 5-year follow-up CI: Confidence interval; M-H: Mantel-Haenszel test; random: Random effect
Figure 5
Figure 5
a) Forest plot of complications in patients with early hepatocellular carcinoma b) Forest plot of in-hospital mortality in patients with early hepatocellular carcinoma CI: Confidence interval; M-H: Mantel-Haenszel test; Random: Random effect
See this image and copyright information in PMC

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