title: Liver transplantation versus liver resection in the treatment of hepatocellular carcinoma: a meta-analysis of observational studies.
abstract: BACKGROUND
  A number of cohort studies have compared the outcomes of liver transplantation (LT) and liver resection (LR) in hepatocellular carcinoma (HCC) patients. However, the effects of LT versus LR remain unclear. We searched electronic databases and reference lists for relevant articles published before February 2013.
  
  
  METHODS
  The primary endpoints were pooled using random-effects models to model potential heterogeneity, including overall survival (OS), disease-free survival, and recurrence rate.
  
  
  RESULTS
  We found similar 1-year OS (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.81-1.43; P=0.61) yet significantly better 3-year OS (OR, 1.47; 95% CI, 1.18-1.84; P<0.001) and 5-year OS (OR, 1.77; 95% CI, 1.45-2.16; P<0.001) after LT compared with LR with relative risk differences of 9% (P<0.001) and 14% (P<0.001), respectively. The 1-, 3-, and 5-year difference-free survival were 13%, 29%, and 39% higher (P<0.001 in all) in LT recipients than LR patients. Additionally, recurrence rate was 30% less (P<0.001) in LT than LR. Furthermore, better 5-year difference-free survival (P<0.001) and recurrence rates (P<0.05) were yielded after LT when patients from the entire HCC population were included.
  
  
  CONCLUSIONS
  When including all the 62 previous studies comparing LT and resection, LT provides increased survival and lower recurrence rates than LR for HCC patients. These results of disease-free survival and recurrence rate are similar among early HCC patients with Child-Turcotte-Pugh class A cirrhosis. However, summary ORs and risk differences cannot be interpreted as causal effects of LT versus LR.
authors.affiliation: 1 Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 2 State Key Laboratory of Oncology in South China, Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. 3 Department of Medical Oncology, Cancer Center of Sun Yat-sen University, Guangzhou, China. 4 Indiana University School of Medicine, Indianapolis, IN. 5 University of Toledo College of Medicine, Toledo, OH. 6 Infobee, Inc., Groton, MA. 7 Address correspondence to: Xiaoshun He, M.D., and Zhiyong Guo, M.D., Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zheng
authors.forename: Wenhua
authors.initials: W
authors.lastname: Liang
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Milgrom
authors.forename: Zhouying
authors.initials: Z
authors.lastname: Zheng
authors.forename: Paul M
authors.initials: PM
authors.lastname: Schroder
authors.forename: Ning S
authors.initials: NS
authors.lastname: Kong
authors.forename: Changsheng
authors.initials: C
authors.lastname: Yang
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Guo
authors.forename: Xiaoshun
authors.initials: X
authors.lastname: He
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology