Is resection equivalent to transplantation for early cirrhotic patients with hepatocellular carcinoma? A meta-analysis.
Publication/Presentation Date
10-1-2012
Abstract
BACKGROUND: Whether liver resection or liver transplantation is optimal therapy for patients with hepatocellular carcinoma (HCC) remains undefined. A meta-analysis was conducted to answer this question.
STUDY DESIGN: This study performed a systematic review of the published literature between January 2000 and April 2012.
RESULTS: Nine retrospective studies, totaling 2,279 patients (989 resected and 1,290 transplanted), met the selection criteria. Older patients with larger tumors and less severe cirrhosis were identified in the resection group. At 1 year, resection demonstrated significantly higher overall [odds ratio (OR) = 1.54; 95 % confidence interval (CI), 1.19-1.98; p = 0.001], but equivalent disease-free survival (OR = 0.93; 95 % CI, 0.53-1.63; p = 0.80). At 5 years, there was no difference in overall survival (OR = 0.86; 95 % CI, 0.61-1.21; p = 0.38), but a higher disease-free survival in transplanted patients was observed (OR = 0.39; 95 % CI, 0.24-0.63; p < 0.001). When limiting our analysis to studies conducted in an intent-to-treat fashion, there was no difference in 5 year overall survival (OR = 1.18; 95 % CI, 0.92-1.51; p = 0.19), but a significantly higher disease-free survival (OR = 0.76; 95 % CI, 0.57-1.00; p = 0.05) in transplanted patients. At 10 years, transplantation had higher overall and disease-free survival rates.
CONCLUSION: Liver transplantation in patients with HCC results in increased late disease-free and overall survival when compared with liver resection. Nonetheless, the benefit of liver transplantation is offset by higher short-term mortality, donor organ availability, and long transplant wait times associated with more patient deaths. Understanding these differences in survival is helpful in guiding treatment. However, a properly controlled prospective trial is needed to define how best to treat HCC patients who are candidates for either therapy.
Volume
16
Issue
10
First Page
1897
Last Page
1909
ISSN
1873-4626
Published In/Presented At
Rahman, A., Assifi, M. M., Pedroso, F. E., Maley, W. R., Sola, J. E., Lavu, H., Winter, J. M., Yeo, C. J., & Koniaris, L. G. (2012). Is resection equivalent to transplantation for early cirrhotic patients with hepatocellular carcinoma? A meta-analysis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(10), 1897–1909. https://doi.org/10.1007/s11605-012-1973-8
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
22836922
Department(s)
Administration and Leadership
Document Type
Article