Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis

Liver transplantation (LT) and liver resection (LR) are two curative treatment options for patients with hepatocellular carcinoma (HCC) meeting the Milan criteria. However, the optimal choice between LT and LR remains contentious. The present meta-analysis aimed to provide additional evidence to optimize treatment decisions for patients with HCC. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane, Web of Science (Medline), OVID, Scopus, China National Knowledge Infrastructure, Value-Added Information Provider, Wanfang and China Biology Medicine, focusing on studies reporting on the prognosis of LR and LT in patients with HCC. The data were analyzed using Review Manager 5.4 software. Random-effects models were employed to compare the 1-, 3-, 5- and 10-year overall survival (OS) rates, disease-free survival (DFS) rates and recurrence rate (RR) between patients who underwent LT and those who underwent LR. In total, 36 studies encompassing 6,839 patients (3,894 in the LR group and 2,945 in the LT group) were included. The analysis revealed no significant difference in 1-year OS rate between the two groups. However, the LT group demonstrated significantly improved OS rates at 3, 5 and 10 years. Additionally, the LT group indicated significantly improved DFS rates at all time points (1, 3, 5 and 10 years) compared with the LR group. Postoperative RR was significantly lower in the LT group compared with that in the LR group. In conclusion, in patients with HCC meeting the Milan criteria, LT provides improvements in OS and DFS rates, and results in a lower RR compared with LR. Therefore, LT should be considered the preferred treatment option for these patients within the Milan criteria if donor organs are available.