title: Is resection equivalent to transplantation for early cirrhotic patients with hepatocellular carcinoma? A meta-analysis.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors: Atiq
authors: A
authors: Rahman
authors: M Mura
authors: MM
authors: Assifi
authors: Felipe E
authors: FE
authors: Pedroso
authors: Warren R
authors: WR
authors: Maley
authors: Juan E
authors: JE
authors: Sola
authors: Harish
authors: H
authors: Lavu
authors: Jordan M
authors: JM
authors: Winter
authors: Charles J
authors: CJ
authors: Yeo
authors: Leonidas G
authors: LG
authors: Koniaris
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome