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. 2024 Mar 18:14:1366607.
doi: 10.3389/fonc.2024.1366607. eCollection 2024.

Liver transplantation vs liver resection in HCC: promoting extensive collaborative research through a survival meta-analysis of meta-analyses

Alessandro Martinino  1 , Angela Bucaro  2 , Francesca Cardella  3 , Ishaan Wazir  4 , Francesco Frongillo  2 , Francesco Ardito  5 , Francesco Giovinazzo  2
Affiliations

Liver transplantation vs liver resection in HCC: promoting extensive collaborative research through a survival meta-analysis of meta-analyses

Alessandro Martinino et al. Front Oncol. .

Abstract

Background: HCC is a major global health concern, necessitating effective treatment strategies. This study conducts a meta-analysis of meta-analyses comparing liver resection (LR) and liver transplantation (LT) for HCC.

Methods: The systematic review included meta-analyses comparing liver resection vs. liver transplantation in HCC, following PRISMA guidelines. Primary outcomes included 5-year overall survival (OS) and disease-free survival (DFS). AMSTAR-2 assessed study quality. Citation matrix and hierarchical clustering validated the consistency of the included studies.

Results: A search identified 10 meta-analyses for inclusion. The median Pearson correlation coefficient for citations was 0.59 (IQR 0.41-0.65). LT showed better 5-year survival and disease-free survival in all HCC (OR): 0.79; 95% CI: 0.67-0.93, I^2:57% and OR: 0.44; 95% CI: 0.25-0.75, I^2:96%). Five-year survival in early HCC and ITT was 0.63 (95% CI: 0.50-0.78, I^2:0%) and 0.60 (95% CI: 0.39-0.92, I^2:0%). Salvage LT vs. Primary LT did not differ between 5-year survival and disease-free survival (OR: 0.62; 95% CI: 0.33-1.15, I^2:0% and 0.93; 95% CI: 0.82-1.04, I^2:0%).

Conclusion: Overall, the study underscores the superior survival outcomes associated with LT over LR in HCC treatment, supported by comprehensive meta-analysis and clustering analysis. There was no difference in survival or recurrence rate between salvage LT and primary LT. Therefore, considering the organ shortage, HCC can be resected and transplanted in case of recurrence.

Keywords: hepatocellular carcinoma; liver resection; liver transplantation; meta-analysis; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
(A) Cluster Dendrogram. (B) Silhouette Plot of Cluster Assignments.
Figure 3
Figure 3
(A) 5-year overall survival in all HCC. (B) Funnel plot. (C) Funnel plot after Trim-and-fill.
Figure 4
Figure 4
(A) 5-year disease-free survival in all HCC. (B) Funnel plot. (C) Funnel plot after Trim-and-fill.
Figure 5
Figure 5
(A) HR overall survival. (B) HR disease free survival.
Figure 6
Figure 6
(A) Five-year survival in early HCC. (B) Five-year survival in ITT.
Figure 7
Figure 7
(A) Salvage vs primary (overall). (B) Salvage vs primary (disease free).
See this image and copyright information in PMC

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