Pascale Marco Maria, Marandola Camilla, Frongillo Francesco, Nure Erida, Agnes Salvatore
General Surgery and Organ Transplant Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy.
Faculty of Medicine, Università Cattolica del Sacro Cuore, 20123 Milan, Italy.
Cancers (Basel). 2025 Apr 29;17(9):1501. doi: 10.3390/cancers17091501.
Liver transplantation (LT) is regarded as a curative approach for patients with hepatocellular carcinoma (HCC), especially those with underlying advanced liver disease. However, the recurrence of HCC post-LT poses significant challenges, with reported rates of 15-20% within the first two years following surgery. Effective management of single-nodule recurrence is critical to improving patient outcomes. This meta-analysis evaluates the efficacy of surgical resection versus locoregional therapies (LRT) in patients with localized HCC recurrence after LT. We adhered to the PRISMA Statement in conducting a thorough search of relevant studies published from 2009 to 2024, ultimately including ten studies that met our eligibility criteria. The results indicate that patients undergoing surgical treatment displayed superior one-year overall survival (OS) rates compared to those receiving LRT (71% vs. 62%, = 0.038), as well as higher one-year disease-free survival (DFS) rates (60% vs. 54%, = 0.042). Notably, patients in the LRT group presented with more advanced HCC characteristics prior to transplantation, including higher rates of microvascular invasion and elevated alpha-fetoprotein levels. Our findings suggest that while surgical resection is associated with better survival outcomes, the choice between surgical and locoregional approaches must be individualized based on tumor characteristics and liver function. The ongoing development of standardized guidelines with the inclusion of immunotherapy or targeted agents will be essential in refining treatment pathways and improving outcomes for patients experiencing HCC recurrence following LT.
肝移植（LT）被视为肝细胞癌（HCC）患者的一种治愈性治疗方法，尤其是那些伴有潜在晚期肝病的患者。然而，肝移植后HCC的复发带来了重大挑战，据报道，术后两年内的复发率为15%-20%。有效管理单结节复发对于改善患者预后至关重要。本荟萃分析评估了手术切除与局部区域治疗（LRT）对肝移植后局部HCC复发患者的疗效。我们遵循PRISMA声明，对2009年至2024年发表的相关研究进行了全面检索，最终纳入了10项符合我们纳入标准的研究。结果表明，与接受LRT的患者相比，接受手术治疗的患者一年总生存率（OS）更高（71%对62%，P=0.038），一年无病生存率（DFS）也更高（60%对54%，P=0.042）。值得注意的是，LRT组患者在移植前具有更晚期的HCC特征，包括更高的微血管侵犯率和更高的甲胎蛋白水平。我们的研究结果表明，虽然手术切除与更好的生存结果相关，但手术和局部区域治疗方法的选择必须根据肿瘤特征和肝功能进行个体化。纳入免疫疗法或靶向药物的标准化指南的不断发展对于完善治疗路径和改善肝移植后HCC复发患者的预后至关重要。
