Locoregional Therapy with Curative Intent versus Primary Liver Transplant for Hepatocellular Carcinoma: Systematic Review and Meta-analysis.

Background: Loco-regional therapy with curative intent (CLRT) followed by salvage liver transplant (SLT) in case of HCC recurrence is an alternative to primary liver transplant (LT) in selected patients with HCC. Methods: We performed a systematic review and meta-analysis of studies comparing the survival of patients treated with CLRT versus LT, stratified by the stage of liver disease, extent of cancer, and whether SLT was offered or not. Results: We included 48 studies involving 9835 patients (5736 patients with CLRT and 4119 patients with primary LT). Five-year overall survival (OS) and disease-free survival (DFS) was worse for all categories of CLRT combined, than for primary LT (odds ratio (OR) for OS: 0.59 (0.48-0.71), p

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