Cross‐sectional studies are widely utilized in medical research to estimate prevalence and examine associations. As such, they can serve as a significant source of data for systematic reviews. However, specific considerations are necessary when evaluating the risk of bias (RoB) of cross‐sectional studies, as several potential biases can undermine the validity, reliability, and robustness of their findings. This article introduces a novel, context‐specific tool designed to assess the RoB of cross‐sectional studies for use in systematic reviews. The proposed tool represents an adaptation of the Newcastle‐Ottawa Scale (NOS), originally developed for cohort and case–control studies. Similar to the original NOS, the new tool (named “NOS‐xs”) features a nine‐star rating system to assess six specific items across three main domains: (i) study sample selection, (ii) assessment of exposure(s) and outcome(s), and (iii) confounding factors. Based on the number of awarded stars, studies are categorized as having high (0–3 stars), moderate (4–6 stars), or low (7–9 stars) RoB. The NOS‐xs tool maintains consistency with the original NOS tool, facilitating its integration into systematic reviews that also include cohort and/or case–control studies. While the NOS‐xs is suited to analytical cross‐sectional studies (i.e., association studies), a simplified version (“NOS‐xs2”) is also introduced for descriptive cross‐sectional studies (i.e., prevalence studies). The NOS‐xs2 features a four‐star rating system to assess three of the six specific items included in the NOS‐xs. To streamline their application, spreadsheets for both NOS‐xs and NOS‐x2 are provided.

AIM: To investigate the efficacy (survival) and safety of treatments for recurrent hepatocellular carcinoma (HCC) in liver transplantation (LT) patients. METHODS: Literature search was performed on available online databases without a time limit until January 2015. Clinical studies describing survival after HCC recurrence in LT patients were retrieved for a full-text evaluation. A total of 61 studies were selected: 13 case reports, 41 retrospective case series, and 7 retrospective comparative studies. RESULTS: Based on all included studies, the mean HCC recurrence rate was 16% of all LTs for HCC. A total of 1021 LT patients experienced HCC recurrence. The median time from LT to HCC recurrence was 13 mo (range 2-132 mo). The majority of patients (67%) presented with HCC extra-hepatic recurrences, involving lung, bone, adrenal gland, peritoneal lymph nodes, and rarely the brain. Overall survival after HCC recurrence was 12.97 mo. Surgical resection of localized HCC recurrence and Sorafenib for controlling systemic spread of HCC recurrence were associated with the higher survival rates (42 and 18 mo, respectively). However, Sorafenib, especially when combined with mTOR, was frequently associated with severe side effects that required dose reduction or discontinuation CONCLUSION: Management of recurrent HCC in LT patients is challenging and associated with poor prognosis independently of the type of treatment.