Liver Transplantation Versus Resection for Single‐Nodule Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis
Carlos Rosa‐Sánchez, María Á. López‐Garrido, Francisco Valverde‐López, Eduardo Redondo‐CerezoABSTRACT
Background
Liver transplantation (LT) and liver resection (LR) are curative options for early‐stage hepatocellular carcinoma (HCC), but the optimal approach for single‐nodule disease remains debated. This systematic review and meta‐analysis compared long‐term outcomes of LT versus LR in patients with single‐nodule HCC.
Methods
PubMed and Cochrane Library were searched (2012–2023) following PRISMA guidelines. Studies comparing LT and LR in adults with single‐nodule HCC were included. Overall survival (OS) and disease‐free survival (DFS) at 1, 3, 5, and 10 years were analyzed using random‐effects models.
Results
Eight studies including 5094 patients (LT: 2289; LR: 2805) were analyzed. No randomized clinical trials were identified. LT showed significantly higher OS at 3, 5, and 10 years, while 1‐year OS was similar. DFS was superior in the LT group at all time points, with progressively larger benefits over time. ITT and tumor‐size sensitivity analyses showed similar findings.
Conclusions
LT was associated with better long‐term OS and DFS than LR in patients with single‐nodule HCC. The consistency of these findings, particularly for DFS, suggests a potential oncological benefit of LT in appropriately selected patients. However, the observational design and substantial baseline differences limit causal interpretation and warrant further comparative research.
Trail Registration
This study was registered prospectively in the International Prospective Register of Systematic Reviews (PROSPERO) under the ID number CRD42024512589.