Liver transplantation for HCC with macrovascular invasion: A systematic review and meta-analysis of observational studies
Rattachement africain : ca, ch, de, ie. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background & Aims Traditional guidelines discourage liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) with macrovascular invasion (MVI). However, emerging evidence suggests long-term survival is possible when LT is preceded by downstaging therapies. Pooled analysis of time-dependent risk factor effect size on overall survival (OS) is warranted to (1) determine the effect size of MVI, (2) estimate risk mitigation through downstaging and (3) design future trials. Methods MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and the Cochrane Register were systematically searched from their inception to January 24, 2023. Studies with comparative oncologic outcomes data between patients with HCC and MVI (MVI group) and HCC patients without MVI (non-MVI group) were included. Frequentist pairwise meta-analysis (random-effects model) was performed for primary outcomes of OS and recurrence-free survival (RFS) at 5 years. Only studies with adjusted effect estimates were considered for analysis. Results Ten studies were included in this systematic review and meta-analysis, contributing 15,899 patients. Seven studies included deceased-donor LT, and four studies included living donor LT. In the quantitative analysis of studies reporting adjusted effect estimates, presence of MVI was associated with lower 5y-OS (HR 2.03; 95%CI 1.60, 2.57; p -value<0.001 | I 2 =55%; p -value=0.05) and 5y-RFS (HR 2.55; 95%CI 1.69, 3.85; p -value<0.001 | I 2 =87%; p -value<0.01). When downstaging was uniformly applied, no statistically significant difference for 5y-OS was observed between the MVI group vs. non-MVI group (HR 1.55; 95%CI 0.88, 2.73; p -value=0.129 | I 2 =46%; p -value=0.17). Conclusion Effective downstaging in carefully selected HCC patients with MVI may achieve survival outcomes approaching those without MVI. Further studies are essential to validate these findings and to clarify which downstaging approaches and tumor characteristics are most likely to confer a transplant benefit. IMPACT AND IMPLICATIONS • This meta-analysis provides the first pooled hazard ratios for the effect of macrovascular invasion (MVI) on liver transplant outcomes, emphasizing the potential for downstaging therapies to mitigate poor prognosis in hepatocellular carcinoma (HCC).• The findings advocate for redefining liver transplant eligibility criteria to incorporate successful downstaging protocols, potentially expanding treatment options for advanced HCC.• These insights underline the need for standardized downstaging protocols and prospective trials to optimize patient selection and outcomes globally.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Liver transplantation for HCC with macrovascular invasion: A systematic review and meta-analysis of observational studies
- Date Crossref
- 01/01/2026
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University Health Network HBP & Multi-Organ Transplant Program pays non établi dans la noticeÉtablissement de santé
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University of Bern pays non établi dans la noticeUniversité ou école supérieure
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University Hospital of Bern pays non établi dans la noticeÉtablissement de santé
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Toronto General Hospital Division of Gastroenterology and Hepatology pays non établi dans la noticeÉtablissement de santé
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Princess Margaret Cancer Centre pays non établi dans la noticeÉtablissement de santé
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Medizinische Hochschule Hannover pays non établi dans la noticeUniversité ou école supérieure
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University College Dublin pays non établi dans la noticeUniversité ou école supérieure
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University of Toronto pays non établi dans la noticeUniversité ou école supérieure
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St. Vincent's University Hospital pays non établi dans la noticeÉtablissement de santé
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Bern University Hospital Department of Visceral Surgery and Medicine pays non établi dans la noticeUniversité ou école supérieure
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Department of Hepatology pays non établi dans la noticeInstitution
HBP & Multi-Organ Transplant Program — University Health Network, University of Bern et University Hospital of Bern, avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.