| Aims:Hepatocellular carcinoma(HCC)is one of the most common causes of cancer death worldwide.Many cohort studies have compared the prognosis of liver transplantation(LT)and liver resection(LR)in hepatocellular carcinoma(HCC)patients who meet the Milan criteria.However,the choice of liver transplantation or hepatectomy is still controversial.The purpose of this study is to provide more evidence-based evidence for the selection of surgical treatment for HCC patients who meet the Milan criteria by Meta-analysis.Methods:Search for all Chinese and English literatures that researched the prognosis of liver resection and liver transplantation in HCC patients who meet the Milan criteria via PubMed,Embase,Cochrane,Web of Science(Medline),OVID,Scopus,CNKI,VIP,Wanfang,and CBM databases.The retrieval time was from the establishment of each database to October 2022.The literatures were searched and screened according to a search strategy based on subject terms combined with free words and strict inclusion and exclusion criteria.Using Review Manager 5.4 software,the 1-year,3-year,5-year,and 10-year overall survival rate,1-year,3-year,5-year,and 10-year disease-free survival rate and recurrence rate in patients with hepatocellular carcinoma were compared in a random-effects models Meta-analysis.Results:There were 37 studies,total 8032 patients(4987 resected and 3045 transplanted),were included.The results from Meta-analysis have showed no significant difference in overall survival rate at 1 year(OR:0.97,95%CI:0.75-1.26,P=0.84)after operation between LR and LT groups.However,the LT group has better overall survival rate at3-years(OR:0.70,95%CI:0.53-0.93,P=0.01),5-year(OR:0.52,95%CI:0.43-0.63,P<0.00001),and 10-year(OR:0.39,95%CI:0.25-0.61,P<0.0001).LT group also showed better disease-free survival rate at 1-year(OR:0.36,95%CI:0.25-0.52,P<0.00001),3-year(OR:0.24,95%CI:0.18-0.31,P<0.00001),5-year(OR:0.20,95%CI:0.16-0.26,P<0.00001)and 10-year(OR:0.12,95%CI:0.07-0.23,P<0.00001)compared with LR group.Further,the postoperative recurrence rate of HCC patients in the LT group was significant lower(12.1% vs 41.3%,P<0.00001).Conclusion:For HCC patients who meet the Milan criteria,LT can provide better overall survival rate,disease-free survival rate,and lower recurrence rate than LR.Therefore,we recommend liver transplantation as the initial surgical treatment for HCC patients within the Milan criteria,provided that donor organs are available.Of course,it is necessary to discuss and evaluate each case on the basis of multidisciplinary consultation,use liver donor resources scientifically and reasonably,and make the donor liver bring the greatest benefits to all patients with liver diseases. |
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