Liver transplantation shows improved five-year survival and recurrence outcomes versus resection for combined hepatocellular-cholangiocarcinoma patients in this meta-analysis

Photo by Richard Catabay / Unsplash

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Published June 5, 2026 Medically reviewed June 5, 2026 Study authors: Kimura Jiro, Asassfeh Ayham, Cooper Matthew, Prasad Kondragunta Rajendra PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Liver transplantation is associated with favorable long-term survival and recurrence outcomes compared with liver resection for combined hepatocellular-cholangiocarcinoma.

This systematic review and meta-analysis evaluated outcomes for patients with combined hepatocellular-cholangiocarcinoma undergoing liver transplantation versus liver resection. Data were pooled from six retrospective studies involving this specific patient population to assess comparative effectiveness.

At one year, the odds ratio for overall survival favored transplantation, though the result was not statistically significant. By three years, the trend continued with a favorable odds ratio, maintaining a non-significant p-value. The most robust finding emerged at five years, where transplantation demonstrated a statistically significant improvement in overall survival compared to resection.

Recurrence-free survival also showed significant benefits for the transplantation group. At one year, the odds ratio favored transplantation significantly. By five years, the advantage was even more pronounced, with a highly significant p-value indicating better long-term recurrence outcomes for transplant recipients.

The study notes limitations due to the reliance on six retrospective studies. Despite these constraints, the practice relevance suggests liver transplantation could be considered for carefully selected patients. No safety data were reported in the included studies.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up60.0 mo

PublishedJun 2026

PMID42068695

View Original Abstract ↓

BACKGROUND: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare and aggressive primary liver cancer. Liver resection (LR) has long been the standard treatment for cHCC-CCA, but it is associated with high recurrence rates and poor long-term prognosis. The significance of liver transplantation (LT) remains controversial. This systematic review and meta-analysis aimed to compare the long-term survival and recurrence outcomes between LT and LR for cHCC-CCA to assess the potential benefit of LT. METHODS: A systematic search of Web of Science, Medline Ovid, Scopus, and Cochrane CENTRAL was conducted using predefined terms related to cHCC-CCA. Records were screened according to PRISMA. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcome was 5-year Overall Survival (OS). Recurrence-free survival (RFS) was a secondary outcome. Meta-analysis was performed using random-effects models. RESULTS: Six retrospective studies met inclusion criteria. NOS scores ranged from 7 to 9. For OS, pooled analyses yielded ORs of 0.67 (95% CI: 0.39-1.15, p = 0.15) at 1 year, 0.70 (95% CI: 0.42-1.17, p = 0.15) at 3 years, and 0.55 (95% CI: 0.38-0.81, p = 0.002) at 5 years. For RFS, pooled analyses yielded ORs of 0.48 (95% CI: 0.30-0.78, p = 0.003) at 1 year and 0.40 (95% CI: 0.27-0.59, p < 0.001) at 5 years. CONCLUSION: LT may be associated with favorable long-term survival and recurrence outcomes compared with LR for cHCC-CCA. These findings suggest that LT could be considered in carefully selected patients.