IDDF2021-ABS-0010 A meta-analysis and meta-regression between liver resection and liver transplant within milian criteria

Abstract

<h3>Background</h3> Hepatocellular carcinoma (HCC) is the dominant form of primary liver cancer and a leading cause of cancer globally. Liver transplantation (LT) confers excellent long-term survival outcomes, but its effectiveness is hampered by the dire shortage of liver allografts. Liver resection (LR) is a promising alternative due to favorable outcomes long-term outcomes. We sought to conduct a meta-analysis to compare the survival outcomes between LT and LR for HCC within the Milan criteria. <h3>Methods</h3> Medline and Embase databases were searched for studies comparing survival data after LT and LR for patients with HCC within the MC. A meta-analysis of hazard ratios (HR) was conducted using the DerSimonian and Laird random-effects model to compare the overall survival (OS) and disease-free survival (DFS) between LR and LT for HCC. Meta-regression was conducted with mixed effects and logit transform on proportional data. <h3>Results</h3> 35 studies involving 18421 patients were included in the analysis.The OS (HR: 1.44, 95% CI: 1.14 - 1.81, p&lt;0.01), DFS (HR: 2.72, 95% CI: 2.18 - 3.39, p&lt;0.01) were significantly worse in LR compared to LT. There was no significant difference between regions. In a sensitivity analysis of uninodular tumours, there was no significant difference in OS (HR: 1.40, 0.91 - 2.17, p=0.13) but significant in DFS (HR: 2.81, CI: 2.06 - 3.83, p&lt;0.01). Meta-regression found a significant increase in mortality between LR and LT in patients with Child-Pugh C cirrhosis on DFS (beta: 0.2254, 95% CI: 0.043-0.4064, p=0.0147) but there was no significant difference arising from different HCC aetiology. With enhance surveillance, there was no significant difference between LR and LT (HR: 1.15, 0.87 - 1.51, p=0.32) but significantly different in DFS (HR: 1.70, 1.07 - 2.67, p=0.02) <h3>Conclusions</h3> The results present an up-to-date analysis of literature in LT vs LR. Optimal surveillance strategy post-resection/transplant remains in contention. Our analysis found no significant difference between LT and LR in overall survival with enhancing surveillance. Regional and income levels differences also exist within the literature, although without significant difference between groups