Is Resection Equivalent to Transplantation for Early Cirrhotic Patients with Hepatocellular Carcinoma? A Meta-Analysis

Atiq Rahman, M. Mura Assifi, Felipe E. Pedroso, Warren R. Maley, Juan E. Sola, Harish Lavu, Jordan M. Winter, Charles J. Yeo, Leonidas Koniaris

Research output: Contribution to journalArticle

29 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1897-1909
Number of pages13
JournalJournal of Gastrointestinal Surgery
Volume16
Issue number10
DOIs
StatePublished - Sep 2012
Externally publishedYes

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Meta-Analysis
Hepatocellular Carcinoma
Transplantation
Disease-Free Survival
Odds Ratio
Confidence Intervals
Liver Transplantation
Survival
Liver
Patient Selection
Fibrosis
Therapeutics
Survival Rate
Retrospective Studies
Tissue Donors
Transplants
Mortality
Neoplasms

Keywords

  • Cancer
  • Hepatectomy
  • Liver resection
  • Liver transplantation
  • Outcomes
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Is Resection Equivalent to Transplantation for Early Cirrhotic Patients with Hepatocellular Carcinoma? A Meta-Analysis. / Rahman, Atiq; Assifi, M. Mura; Pedroso, Felipe E.; Maley, Warren R.; Sola, Juan E.; Lavu, Harish; Winter, Jordan M.; Yeo, Charles J.; Koniaris, Leonidas.

In: Journal of Gastrointestinal Surgery, Vol. 16, No. 10, 09.2012, p. 1897-1909.

Research output: Contribution to journalArticle

Rahman, Atiq ; Assifi, M. Mura ; Pedroso, Felipe E. ; Maley, Warren R. ; Sola, Juan E. ; Lavu, Harish ; Winter, Jordan M. ; Yeo, Charles J. ; Koniaris, Leonidas. / Is Resection Equivalent to Transplantation for Early Cirrhotic Patients with Hepatocellular Carcinoma? A Meta-Analysis. In: Journal of Gastrointestinal Surgery. 2012 ; Vol. 16, No. 10. pp. 1897-1909.
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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.",
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AU - Rahman, Atiq

AU - Assifi, M. Mura

AU - Pedroso, Felipe E.

AU - Maley, Warren R.

AU - Sola, Juan E.

AU - Lavu, Harish

AU - Winter, Jordan M.

AU - Yeo, Charles J.

AU - Koniaris, Leonidas

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N2 - 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.

AB - 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.

KW - Cancer

KW - Hepatectomy

KW - Liver resection

KW - Liver transplantation

KW - Outcomes

KW - Treatment

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