Is Resection or Transplantation the ideal Treatment in Patients with Hepatocellular Carcinoma in Cirrhosis if Both Are Possible? A Systematic ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-05-28

AUTHORS

Andrea Proneth, Florian Zeman, Hans J. Schlitt, Andreas A. Schnitzbauer

ABSTRACT

BackgroundHepatocellular carcinoma (HCC) is one of the most common neoplasms. Curative treatment options include liver resection (LR) and transplantation (LT). Organ shortage leads to discussion whether resectable HCC in cirrhosis should undergo LT or LR. MethodsSystematic review and metaanalysis of studies investigating LR and/or LT were performed. Overall survival (OS) and disease-free survival (DFS) were analyzed. Studies reporting 5-year OS of LR versus LT in an intention-to-treat fashion were included in a metaanalysis. ResultsNo randomized controlled trial was detected. Seventy publications were eligible for analysis. The 5-year OS revealed a better outcome for LT than LR (60.9 vs. 49.4 %; p < 0.001). Descriptive DFS data indicate superiority of LT at 3 years (62.0 vs. 45.9 %; p < 0.001) and 5 years (58 vs. 33.9 %; p < 0.001). Comparing the 5-year OS of transplantation and resection in a metaanalysis by use of the seven studies with a total of 1,572 patients, no survival advantage could be found (odds ratio, 0.84; 95 % confidence interval, 0.48–1.48; p = 0.55).ConclusionsA low quality of evidence data suggests the following: resectable HCC should primarily be resected as good alternative to liver transplantation in patients in whom both seem feasible. Randomized controlled trials or at least systematic evaluation of a cohort of patients in which resection and transplantation seem possible should be performed in a registry. This analysis should include intention-to-treat analysis of patients on the waiting list who do not proceed to a potential curative treatment. More... »

PAGES

3096-3107

References to SciGraph publications

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  • 2007-05-24. An Analysis of Resection vs Transplantation for Early Hepatocellular Carcinoma: Defining the Optimal Therapy at a Single Institution in ANNALS OF SURGICAL ONCOLOGY
  • 2010-06-11. Prognostic Impact of Underlying Liver Fibrosis and Cirrhosis After Curative Resection of Hepatocellular Carcinoma in WORLD JOURNAL OF SURGERY
  • 2009-05-06. Is Liver Resection Justified in Advanced Hepatocellular Carcinoma? Results of an Observational Study in 464 Patients in JOURNAL OF GASTROINTESTINAL SURGERY
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  • 2002-11. Comparison of hepatic resection and hepatic transplantation in the treatment of hepatocellular carcinoma among cirrhotic patients in ANNALS OF SURGICAL ONCOLOGY
  • 2007-08-10. Long Term Outcome and Prognostic Factors for Large Hepatocellular Carcinoma (10 cm or more) after Surgical Resection in ANNALS OF SURGICAL ONCOLOGY
  • 2010-02-11. Surgical treatment for early hepatocellular carcinoma: comparison of resection and liver transplantation in JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY
  • 2008-03-05. Surgical Treatment of Hepatocellular Carcinoma beyond Milan Criteria. Results of Liver Resection, Salvage Transplantation, and Primary Liver Transplantation in ANNALS OF SURGICAL ONCOLOGY
  • 1998-06. Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization in TRANSPLANT INTERNATIONAL
  • 2011-03-01. Resection of a Transplantable Single-Nodule Hepatocellular Carcinoma in Child-Pugh Class A Cirrhosis: Factors Affecting Survival and Recurrence in WORLD JOURNAL OF SURGERY
  • 2008-11-26. Comparison of Recurrence of Hepatocellular Carcinoma After Resection in Patients with Cirrhosis to Its Occurrence in a Surveilled Cirrhotic Population in ANNALS OF SURGICAL ONCOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1245/s10434-014-3808-1

    DOI

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    DIMENSIONS

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    PUBMED

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