Objective: To systematically evaluate the clinical outcomes of HCC patients undergoing LT and LR.

Methods: A search of PubMed/Medline, Embase and Cochrane library databases was supplemented by manual search of bibliographies of key retrieved articles. Reference lists from review articles were also searched. Sixty-two controlled clinical studies with 10170 participants were included in the current meta-analysis. Overall survival (OS), disease-free survival (DFS), and recurrence rate were assessed.

Results: We found similar 1-year OS (odds ratio (OR) =1.08 [95% confidence interval 0.81−1.43], p=0.61), yet significantly better 3-year OS (OR=1.47 [1.18−1.84], p<0.001) and 5-year OS (OR=1.77 [1.45−2.16], p<0.001) following LT compared to LR with relative risk differences of 9% (p<0.001) and 14% (p<0.001)[Figure 1], respectively.

The 1-year, 3-year, and 5-year DFS were 13%, 29%, and 39% higher (p<0.001 in all) in LT recipients than LR patients (OR=2.09 [1.51−2.88], 3.79 [2.92−4.92], 5.58 [4.12−7.55] [Figure 2], respectively; p< 0.001 in all).

Additionally, recurrence rate was 30% less (p<0.001) in LT than LR (OR=0.20 [0.15−0.28], p<0.001). Furthermore, while LT was superior to LR in DFS throughout our cumulative meta-analysis, it showed that 1997 and 1999 were the years when LT began to provide lower pooled recurrence rate and better OS, respectively. For early HCC patients with Child-Turcotte-Pugh Class A cirrhosis, similar 5-year OS (p=0.22) between LT and LR were obtained, as well as consistently better 5-year DFS (p<0.001) and recurrence results (p<0.05) in LT with those of the whole HCC population.

Conclusion: LT provides increased survival and lower recurrence rates than LR for HCC patients. These results of disease-free survival and recurrence rate are reproducible among early HCC patients with Child-Turcotte-Pugh Class A cirrhosis.

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