Background 95% CI 1.60-2.57; p <0.001; I2 = 55%; p = 0.05) and 5-year RFS (HR 2.55; 95% CI 1.69-3.85; p <0.001; I2 = 87%; p <0.01). When downstaging was uniformly applied, no statistically significant difference for 5-year OS was observed between the MVI group and non-MVI group (HR 1.55; 95% CI 0.88-2.73; p =0.129; I2 = 46%; p = 0.17).Conclusions Effective downstaging in carefully selected patients with HCC with MVI could achieve survival outcomes approaching those of patients without MVI. Further studies are essential to validate these findings and to clarify which downstaging approaches and tumor characteristics are most likely to confer a transplant benefit.Impact And Implications This meta-analysis provides the first pooled HRs for the effect of MVI on LT outcomes, emphasizing the potential for downstaging therapies to mitigate poor prognosis in HCC. The findings advocate for redefining LT eligibility criteria to incorporate successful downstaging protocols, potentially expanding treatment options for advanced HCC. These insights underline the need for standardized downstaging protocols and prospective trials to optimize patient selection and outcomes globally for LT.
Ladak et al. (Thu,) studied this question.