The Treatment Effect of Liver Transplantation versus Liver Resection for HCC: A Review and Future Perspectives
| العنوان: | The Treatment Effect of Liver Transplantation versus Liver Resection for HCC: A Review and Future Perspectives |
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| المؤلفون: | Roeland F. de Wilde, Robert A. de Man, Jan N. M. IJzermans, Berend R. Beumer, Herold J. Metselaar, Wojciech G. Polak |
| المصدر: | Cancers Cancers, Vol 13, Iss 3730, p 3730 (2021) |
| بيانات النشر: | MDPI AG, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Oncology, Research design, Cancer Research, medicine.medical_specialty, regression discontinuity, media_common.quotation_subject, medicine.medical_treatment, Review, 030230 surgery, Liver transplantation, Milan criteria, survival, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Internal medicine, Medicine, RC254-282, media_common, Selection bias, liver transplantation, business.industry, Confounding, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, hepatocellular carcinoma, Evidence-based medicine, medicine.disease, Hepatocellular carcinoma, Causal inference, liver resection, 030211 gastroenterology & hepatology, business |
| الوصف: | Simple Summary For patients with early-stage hepatocellular carcinoma, it is important to know whether liver transplantation offers a survival benefit over liver resection. Patients receiving transplantation often have different characteristics in terms of their cancer stage and liver function compared to those being resected. This makes a comparison of the two treatment modalities challenging. This article presents a comprehensive review of research articles comparing these two treatments and discusses their strengths and weaknesses. Furthermore, we suggest a new research design that uses a treatment guideline to help ensure that the groups are more comparable. Hereby, we enable future studies to assess whether liver transplantation offers a survival benefit over liver resection in patients that are eligible for both treatments. Abstract For patients presenting with hepatocellular carcinoma within the Milan criteria, either liver resection or liver transplantation can be performed. However, to what extent either of these treatment options is superior in terms of long-term survival is unknown. Obviously, the comparison of these treatments is complicated by several selection processes. In this article, we comprehensively review the current literature with a focus on factors accounting for selection bias. Thus far, studies that did not perform an intention-to-treat analysis conclude that liver transplantation is superior to liver resection for early-stage hepatocellular carcinoma. In contrast, studies performing an intention-to-treat analysis state that survival is comparable between both modalities. Furthermore, all studies demonstrate that disease-free survival is longer after liver transplantation compared to liver resection. With respect to the latter, implications of recurrences for survival are rarely discussed. Heterogeneous treatment effects and logical inconsistencies indicate that studies with a higher level of evidence are needed to determine if liver transplantation offers a survival benefit over liver resection. However, randomised controlled trials, as the golden standard, are believed to be infeasible. Therefore, we suggest an alternative research design from the causal inference literature. The rationale for a regression discontinuity design that exploits the natural experiment created by the widely adopted Milan criteria will be discussed. In this type of study, the analysis is focused on liver transplantation patients just within the Milan criteria and liver resection patients just outside, hereby ensuring equal distribution of confounders. |
| تدمد: | 2072-6694 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6dc1c864d9b9c1067b3b1ccf7b3a0c4cTest https://doi.org/10.3390/cancers13153730Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....6dc1c864d9b9c1067b3b1ccf7b3a0c4c |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20726694 |
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