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Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis

  • Authors:
    • Jiling Wang
    • Zheng Pan
    • Yongzheng Wang
    • Yanshuo Ye
    • Wei Li
  • View Affiliations / Copyright

    Affiliations: Department of Hepatobiliary‑Pancreatic Surgery, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
    Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 94
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    Published online on: January 5, 2026
       https://doi.org/10.3892/ol.2026.15447
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Abstract

Liver transplantation (LT) and liver resection (LR) are two curative treatment options for patients with hepatocellular carcinoma (HCC) meeting the Milan criteria. However, the optimal choice between LT and LR remains contentious. The present meta‑analysis aimed to provide additional evidence to optimize treatment decisions for patients with HCC. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane, Web of Science (Medline), OVID, Scopus, China National Knowledge Infrastructure, Value‑Added Information Provider, Wanfang and China Biology Medicine, focusing on studies reporting on the prognosis of LR and LT in patients with HCC. The data were analyzed using Review Manager 5.4 software. Random‑effects models were employed to compare the 1‑, 3‑, 5‑ and 10‑year overall survival (OS) rates, disease‑free survival (DFS) rates and recurrence rate (RR) between patients who underwent LT and those who underwent LR. In total, 36 studies encompassing 6,839 patients (3,894 in the LR group and 2,945 in the LT group) were included. The analysis revealed no significant difference in 1‑year OS rate between the two groups. However, the LT group demonstrated significantly improved OS rates at 3, 5 and 10 years. Additionally, the LT group indicated significantly improved DFS rates at all time points (1, 3, 5 and 10 years) compared with the LR group. Postoperative RR was significantly lower in the LT group compared with that in the LR group. In conclusion, in patients with HCC meeting the Milan criteria, LT provides improvements in OS and DFS rates, and results in a lower RR compared with LR. Therefore, LT should be considered the preferred treatment option for these patients within the Milan criteria if donor organs are available.
View Figures

Figure 1

Flow diagram for included articles.
LT, liver transplantation; LR, liver resection; HCC, hepatocellular
carcinoma.

Figure 2

Forest plot of overall survival in
patients meeting the Milan criteria at the (A) 1-year, (B) 3-year,
(C) 5-year and (D) 10-year follow-ups. All comparisons were based
on random-effects meta-analysis. Boxes represent the odds ratio of
each study, with box sizes proportional to the study weight in the
analysis. Segments represent the 95% CI of each study. Diamonds
represent the overall effect size and diamond widths represent the
overall 95% CI. CI, confidence interval; M-H, Mantel-Haenszel test;
random, random effect; LT, liver transplantation; LR, liver
resection.

Figure 3

Forest plot of disease-free survival
in patients meeting the Milan criteria at the (A) 1-year, (B)
3-year, (C) 5-year and (D) 10-year follow-ups. All comparisons were
based on random-effects meta-analysis. Boxes represent the odds
ratio of each study, with box sizes proportional to the study
weight in the analysis. Segments represent the 95% CI of each
study. Diamonds represent the overall effect size and diamond
widths represent the overall 95% CI. CI, confidence interval; M-H,
Mantel-Haenszel test; random, random effect; LT, liver
transplantation; LR, liver resection.

Figure 4

Forest plot of recurrence rate in
patients meeting the Milan criteria. All comparisons were based on
random-effects meta-analysis. Boxes represent the odds ratio of
each study, with box sizes proportional to the study weight in the
analysis. Segments represent the 95% CI of each study. Diamonds
represent the overall effect size and diamond widths represent the
overall 95% CI. CI, confidence interval; M-H, Mantel-Haenszel test;
random, random effect; LT, liver transplantation; LR, liver
resection.

Figure 5

Funnel plots evaluating publication
bias, including all studies assessing (A) 1-year, (B) 3-year and
(C) 5-year OS rates. OS, overall survival; OR, odds ratio.

Figure 6

Funnel plots evaluating publication
bias, including all studies assessing (A) 1-year, (B) 3-year and
(C) 5-year DFS rates. DFS, disease-free survival; OR, odds
ratio.
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Copy and paste a formatted citation
Spandidos Publications style
Wang J, Pan Z, Wang Y, Ye Y and Li W: Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis. Oncol Lett 31: 94, 2026.
APA
Wang, J., Pan, Z., Wang, Y., Ye, Y., & Li, W. (2026). Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis. Oncology Letters, 31, 94. https://doi.org/10.3892/ol.2026.15447
MLA
Wang, J., Pan, Z., Wang, Y., Ye, Y., Li, W."Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis". Oncology Letters 31.3 (2026): 94.
Chicago
Wang, J., Pan, Z., Wang, Y., Ye, Y., Li, W."Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis". Oncology Letters 31, no. 3 (2026): 94. https://doi.org/10.3892/ol.2026.15447
Copy and paste a formatted citation
x
Spandidos Publications style
Wang J, Pan Z, Wang Y, Ye Y and Li W: Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis. Oncol Lett 31: 94, 2026.
APA
Wang, J., Pan, Z., Wang, Y., Ye, Y., & Li, W. (2026). Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis. Oncology Letters, 31, 94. https://doi.org/10.3892/ol.2026.15447
MLA
Wang, J., Pan, Z., Wang, Y., Ye, Y., Li, W."Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis". Oncology Letters 31.3 (2026): 94.
Chicago
Wang, J., Pan, Z., Wang, Y., Ye, Y., Li, W."Prognosis of liver transplantation and hepatectomy in patients with hepatocellular carcinoma meeting the Milan criteria: A systematic review and meta‑analysis". Oncology Letters 31, no. 3 (2026): 94. https://doi.org/10.3892/ol.2026.15447
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