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.
背景：多项荟萃分析已比较肝切除术（LR）与肝移植术（LT）治疗肝细胞癌（HCC）的疗效，但原始研究存在重叠且结局定义存在异质性，使结果解读复杂化。方法：本研究遵循PRISMA/PRIOR指南开展伞状综述（PROSPERO注册号CRD420251069248）。检索PubMed、Embase和CENTRAL数据库中2000年1月1日至2025年9月30日发表的荟萃分析。纳入定量比较LT与LR的荟萃分析，同时对一项荟萃分析的系统评价进行叙述性综合。统一效应方向后，基于风险比（HR）的汇总数据（LR:LT；数值>1支持LT）采用随机效应模型合并，而因终点定义异质性，基于比值比（OR）的汇总结果仅作定性描述。结果：共纳入4项定量荟萃分析和1项荟萃分析系统评价。合并HR结果证实LT具有生存优势：总生存期（OS）HR为1.35（95% CI 1.17–1.55），无病生存期（DFS）HR为2.58（95% CI 2.25–2.96）。近期荟萃分析的OR结果方向一致但未进行合并。结论：本伞状综述证实，对于HCC患者，LT在长期OS和DFS方面均优于LR，这一结论在米兰标准及扩展标准中均保持稳健性。通过意向治疗分析、病毒病因学（乙型肝炎病毒/丙型肝炎病毒）、时代及地域等亚组分析，并采用避免研究重叠的方法学保障，进一步强化了LT作为符合条件患者首选策略的论证，而LR在供体有限时仍是重要选择。
肿瘤(癌症)患者之家