As medical research continues to advance, so do the best methods for hepatocellular carcinoma (HCC). For this deadly disease, liver transplantation (LT) and liver resection (LR) are the two main means, and the difference in their effectiveness has always been the focus of attention in the medical community. Recently, a large-scale meta-analysis study published in the journal HBSN revealed differences in survival outcomes between the two methods, providing an important new basis for medical decision-making.
The depth and breadth of the research
The research team screened 2,278 studies and included 35 of them, covering 18,421 HCC patients who underwent liver transplantation or liver resection within the Milan criteria. These patients come from countries with different geographic regions and income levels, and the time span of the studies is also very broad. By using a random-effects model for meta-analysis and meta-regression analysis, studies provide a comprehensive view of how liver resection and liver transplantation compare overall survival (OS) and disease-free survival (DFS).
Key findings
The central finding of the study was that patients who underwent liver resection performed worse in terms of OS and DFS compared to liver transplantation. Specifically, the risk of death from liver removal is almost 50% higher and the risk is three times higher than that of liver transplantation. These findings appear to provide strong support for liver transplantation as a preferred option for HCC.
However, in patients with mononodular lesions, there was no significant difference in OS between liver resection and liver transplantation, although liver resection still performed poorly in terms of DFS. Considering the organ shortage and long-term immunosuppression** challenges faced by liver transplantation, this provides an important ** selection consideration for patients with mononodular lesions.
The choice faced by Asian patients: there was no significant difference in overall survival between liver transplantation and resection
The study also revealed the impact of regional differences on survival outcomes. In North America and Europe, liver resection was associated with worse OS compared to liver transplantation, while in Asia, there was no significant difference in OS between the two methods.
The reason for the lack of significant differences in OS in Asia may be related to a number of factors. First of all, hepatitis B virus (HBV) infection is the main cause of liver cancer in Asia, unlike hepatitis C virus (HCV) infection in North America and Europe. Because HBV infection is more prevalent in Asia, baseline characteristics may vary in patients with liver cancer.
Second, medical practices and monitoring strategies in Asia may also influence post-survival outcomes. Healthcare systems in the Asian region are likely to focus more on early detection and**, including the use of more advanced biomarkers such as PIVKA-II and AFP-L3 for surveillance**.
Finally, the proportion of living-donor liver transplants (LD liver transplants) in Asia is much higher than in North America and Europe.
Times are changing: the difference between liver resection and transplantation is shrinking
Over time, the differences in OS between liver resection and liver transplant are also changing. Studies done prior to 2010 showed that liver resection was significantly lower in OS than liver transplantation, but after 2010, this difference became less significant. The difference in survival rates between patients with hepatocellular carcinoma who undergo liver resection and liver transplantation before and after is mainly due to the following factors:
Advances in medical technology: After 2010, significant advances in medical technology, particularly surgical techniques and medications**, may improve the survival rate of patients with liver resection.
Improved postoperative monitoring and follow-up: More advanced monitoring techniques and follow-up procedures help physicians detect and metastases in a timely manner, improving the chances of survival for patients with liver resection.
Improved early diagnosis: Early diagnosis of liver cancer means that patients can start receiving it at a mild state of illness**, which is beneficial for improved survival.
Changes in the field of liver transplantation: Improvements in liver transplantation technology and adjustments to donor standards may also have affected liver transplant survival.
The importance of monitoring strategies
Notably, there was no significant difference in OS between patients who underwent liver transplantation and liver resection with the enhanced surveillance strategy. This highlights the potential value of comprehensive postoperative surveillance in improving survival in patients with liver resection. Early detection of HCC** and timely intervention are essential to improve survival.
Conclusions and prospects
In traditional medical concepts, liver transplantation is often regarded as the best choice for hepatocellular carcinoma. However, this study challenges this notion by revealing that liver resection is also an effective means in specific circumstances, especially for patients with single-nodular HCC. In addition, changes in geographic location and time have a significant impact on performance. In Asia, there was no significant difference in overall survival between liver resection and liver transplantation. Finally, with advances in medical technology, survival outcomes for liver resection have also improved in recent years.
Therefore, the specific case and regional characteristics need to be taken into account when developing the HCC** protocol. Going forward, personalized approaches and continued medical technology developments will continue to improve the quality of life and survival rates of HCC patients.
References. koh jh, tan djh, ong y, et al. liver resection versus liver transplantation for hepatocellular carcinoma within milan criteria: a meta-analysis of 18,421 patients. hepatobiliary surg nutr. 2022;11(1):78-93.
*: International Hepatobiliary Information.