Jin Hean Koh1, Darren Jun Hao Tan1, Yuki Ong1, Wen Hui Lim1, Cheng Han Ng1, Phoebe Wen Lin Tay1, Jie Ning Yong1, Mark D Muthiah1,2,3, Eunice X Tan1,2,3, Ning Qi Pang3,4, Beom Kyung Kim5,6, Nicholas Syn1,7, Alfred Kow3,4, Brian K P Goh8,9, Daniel Q Huang1,2,3. 1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 2. Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore. 3. National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore. 4. Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore. 5. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. 6. Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea. 7. Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. 8. Department of Hepato-Pancreato-Biliary and Transplant Surgery, Division of Surgery, Singapore General Hospital, Singapore, Singapore. 9. Liver Transplant Service, SingHealth Duke-NUS Transplant Centre, Singapore, Singapore.
Abstract
Background: Outcomes after liver resection (LR) and liver transplantation (LT) for hepatocellular carcinoma (HCC) are heterogenous and may vary by region, over time periods and disease burden. We aimed to compare overall survival (OS) and disease-free survival (DFS) between LT versus LR for HCC within the Milan criteria. Methods: Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria. Meta-analyses and metaregression were conducted using random-effects models. Results: We screened 2,278 studies and included 35 studies with 18,421 patients. LR was associated with poorer OS [hazard ratio (HR) =1.44; 95% confidence interval (CI): 1.14-1.81; P<0.01] and DFS (HR =2.71; 95% CI: 2.23-3.28; P<0.01) compared to LT, with similar findings among intention-to-treat (ITT) studies. In uninodular disease, OS in LR was comparable to LT (P=0.13) but DFS remained poorer (HR =2.95; 95% CI: 2.30-3.79; P<0.01). By region, LR had poorer OS versus LT in North America and Europe (P≤0.01), but not Asia (P=0.25). LR had inferior survival versus LT in studies completed before 2010 (P=0.01), but not after 2010 (P=0.12). Cohorts that underwent enhanced surveillance had comparable OS after LT and LR (P=0.33), but cohorts undergoing usual surveillance had worse OS after LR (HR =1.95; 95% CI: 1.24-3.07; P<0.01). Conclusions: Mortality after LR for HCC is nearly 50% higher compared to LT. Survival between LR and LT were similar in uninodular disease. The risk of recurrence after LR is threefold that of LT. 2022 Hepatobiliary Surgery and Nutrition. All rights reserved.
Background: Outcomes after liver resection (LR) and liver transplantation (LT) for hepatocellular carcinoma (HCC) are heterogenous and may vary by region, over time periods and disease burden. We aimed to compare overall survival (OS) and disease-free survival (DFS) between LT versus LR for HCC within the Milan criteria. Methods: Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria. Meta-analyses and metaregression were conducted using random-effects models. Results: We screened 2,278 studies and included 35 studies with 18,421 patients. LR was associated with poorer OS [hazard ratio (HR) =1.44; 95% confidence interval (CI): 1.14-1.81; P<0.01] and DFS (HR =2.71; 95% CI: 2.23-3.28; P<0.01) compared to LT, with similar findings among intention-to-treat (ITT) studies. In uninodular disease, OS in LR was comparable to LT (P=0.13) but DFS remained poorer (HR =2.95; 95% CI: 2.30-3.79; P<0.01). By region, LR had poorer OS versus LT in North America and Europe (P≤0.01), but not Asia (P=0.25). LR had inferior survival versus LT in studies completed before 2010 (P=0.01), but not after 2010 (P=0.12). Cohorts that underwent enhanced surveillance had comparable OS after LT and LR (P=0.33), but cohorts undergoing usual surveillance had worse OS after LR (HR =1.95; 95% CI: 1.24-3.07; P<0.01). Conclusions: Mortality after LR for HCC is nearly 50% higher compared to LT. Survival between LR and LT were similar in uninodular disease. The risk of recurrence after LR is threefold that of LT. 2022 Hepatobiliary Surgery and Nutrition. All rights reserved.
Authors: Josep M Llovet; Robin Kate Kelley; Augusto Villanueva; Amit G Singal; Eli Pikarsky; Sasan Roayaie; Riccardo Lencioni; Kazuhiko Koike; Jessica Zucman-Rossi; Richard S Finn Journal: Nat Rev Dis Primers Date: 2021-01-21 Impact factor: 52.329
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702
Authors: Matthew J Page; Joanne E McKenzie; Patrick M Bossuyt; Isabelle Boutron; Tammy C Hoffmann; Cynthia D Mulrow; Larissa Shamseer; Jennifer M Tetzlaff; Elie A Akl; Sue E Brennan; Roger Chou; Julie Glanville; Jeremy M Grimshaw; Asbjørn Hróbjartsson; Manoj M Lalu; Tianjing Li; Elizabeth W Loder; Evan Mayo-Wilson; Steve McDonald; Luke A McGuinness; Lesley A Stewart; James Thomas; Andrea C Tricco; Vivian A Welch; Penny Whiting; David Moher Journal: BMJ Date: 2021-03-29
Authors: Daniel Q Huang; Mark D Muthiah; Lei Zhou; Halisah Jumat; Wan Xin Tan; Guan Huei Lee; Seng Gee Lim; Alfred Kow; Glenn Bonney; Iyer Shridhar; Yi Ting Lim; Aileen Wee; Yin Huei Pang; Gwyneth Soon; Pierce Chow; Yock Young Dan Journal: Cell Mol Gastroenterol Hepatol Date: 2020-12-16
Authors: V Mazzaferro; E Regalia; R Doci; S Andreola; A Pulvirenti; F Bozzetti; F Montalto; M Ammatuna; A Morabito; L Gennari Journal: N Engl J Med Date: 1996-03-14 Impact factor: 176.079
Authors: Rosyli F Reveron-Thornton; Margaret L P Teng; Eunice Yewon Lee; Andrew Tran; Sean Vajanaphanich; Eunice X Tan; Sanjna N Nerurkar; Rui Xin Ng; Readon Teh; Debi Prasad Tripathy; Takanori Ito; Taku Tanaka; Nozomi Miyake; Biyao Zou; Connie Wong; Hidenori Toyoda; Carlos O Esquivel; C Andrew Bonham; Mindie H Nguyen; Daniel Q Huang Journal: Hepatol Commun Date: 2022-03-02