Liver Transplantation Versus Resection for Hepatocellular Carcinoma: An Umbrella and Meta-Meta-Analysis of Published Evidence, 2000–2025
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Multiple meta-analyses have compared liver resection (LR) with liver transplantation (LT) for hepatocellular carcinoma (HCC), but overlapping primary studies and heterogeneous outcome definitions have complicated interpretation. METHODS: A PRISMA/PRIOR-compliant umbrella review (PROSPERO CRD420251069248) was conducted. PubMed, Embase, and CENTRAL were searched for meta-analyses published between 1 January 2000 and 30 September 2025. Quantitative meta-analyses comparing LT and LR were included, while one systematic review of meta-analyses was synthesised narratively. Effect directions were standardised; hazard ratio (HR)-based summaries (LR:LT; values > 1 favour LT) were pooled using random-effects models, whereas odds ratio (OR)-based summaries were described qualitatively because of heterogeneity in endpoint definitions. RESULTS: Four quantitative meta-analyses and one systematic review of meta-analyses met the inclusion criteria. Pooled HRs confirmed LT superiority: overall survival (OS) HR 1.35 (95% CI 1.17-1.55) and disease-free survival (DFS) HR 2.58 (95% CI 2.25-2.96). OR-based summaries from recent meta-analyses were directionally consistent but were not pooled. CONCLUSIONS: This umbrella synthesis demonstrates that LT provides superior long-term OS and DFS compared with LR for HCC, with consistent robustness across both Milan and extended selection criteria. Methodological safeguards against study overlap and subgroup insights-including intention-to-treat analyses, viral etiology (hepatitis B virus/hepatitis C virus), era, and geographic region-reinforce LT as the preferred strategy for eligible patients, while LR remains a critical option where graft availability is limited.
Source: Cancers
Authors: Seoung Hoon Kim, Byeong Ho An, Jin A Lee, Go Woon Jeong
Institution: National Cancer Center
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W4417498952