Background: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.Methods: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.Results:The results indicate that patients undergoing surgical treatment displayed superior one-year overall survival (OS) rates compared to those receiving LRT (71% vs. 62%,p= 0.038), as well as higher one-year disease-free survival (DFS) rates (60% vs. 54%,p= 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.Conclusions: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.
背景：肝移植被认为是肝细胞癌患者，特别是伴有晚期基础肝病患者的根治性治疗手段。然而，肝移植术后肝癌复发构成重大临床挑战，文献报道术后两年内复发率达15–20%。有效管理单结节复发对改善患者预后至关重要。 方法：本荟萃分析评估了肝移植后局部肝癌复发患者接受手术切除与局部区域治疗的疗效差异。我们遵循PRISMA声明，系统检索了2009年至2024年间发表的相关研究，最终纳入符合标准的十项研究。 结果：结果显示，接受手术治疗的患者一年总生存率显著优于局部区域治疗组（71% vs. 62%，p=0.038），一年无病生存率也更高（60% vs. 54%，p=0.042）。值得注意的是，局部区域治疗组患者在移植前具有更晚期的肝癌特征，包括更高的微血管侵犯率和甲胎蛋白水平。 结论：本研究提示，虽然手术切除与更好的生存结局相关，但具体治疗方式的选择应基于肿瘤特征和肝功能状况进行个体化决策。未来制定包含免疫治疗或靶向药物的标准化指南，对于优化肝移植术后肝癌复发患者的治疗路径、改善临床预后具有重要意义。
肿瘤(癌症)患者之家