Liver Transplantation Versus Resection for Single-Nodule Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Abstract

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.