Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutaneous ethanol injection

Abstract

BACKGROUND Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resection or percutaneous ethanol injection (PEI). In this study, certain clinical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients with single HCC < 5 cm treated by PEI. METHODS After PEI treatment of HCC, the patients were followed for a mean period of 33 ± 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child‐Pugh score, hepatitis B virus surface antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha‐fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the posttreatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated. RESULTS The cumulative 4‐year intrahepatic recurrence rate of HCC was 62%. The log rank test indicated that, among pretreatment parameters, time from cirrhosis diagnosis >6 years (P = 0.05) and AFP level before PEI of >25 ng/mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P < 0.002). With regard to posttreatment parameters, an AFP level 1 month after PEI of >13 ng/mL was shown to be significantly related to tumor recurrence by the log rank test (P < 0.0001). CONCLUSIONS Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow‐up program. Cancer 1997; 79:1501‐8. © 1997 American Cancer Society.

Branched-chain Amino Acid Granules Improve the Non-protein Respiratory Quotient after Radiofrequency Ablation

“…Disturbances in energy metabolism can impair liver regeneration (28), and the strong disturbance in energy metabolism induced by RFA inhibits the recovery of the liver function after the procedure. Deterioration of the liver function after RFA is problematic, as HCC patients exhibit a high incidence of recurrence due to the development of minor intrahepatic metastasis and multicentric carcinogenesis (7)(8)(9). Therefore, deterioration of the liver function after RFA can result in inadequate treatment in cirrhotic patients with HCC develop recurrence after RFA.…”

“…RFA against HCC sometimes worsens the liver parenchymal function (6). Deterioration of the liver function after RFA is problematic because HCC patients experience a high incidence of recurrence due to the development of minor intrahepatic metastasis and multicentric carcinogenesis (7)(8)(9). In order to provide adequate treatment in cirrhotic patients, the residual liver function must be maintained.…”

Risk factors for the recurrence of hepatocellular carcinoma after radiofrequency ablation of hepatocellular carcinoma in patients with hepatitis C

“…RFA is successful for achieving a one-session treatment for patients with small HCC using RFA with CT assistance, and RFA with CT assistance is effective for the treatment of patients with small HCC [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . One of the advantages of RFA is that it can be repeatedly performed, can be combined with TACE, and can also be used according to the features of the disease and the response [7] .…”

Effects of interferon alpha treatment on recurrence and survival after complete resection or ablation of hepatocellular carcinoma: A meta‐analysis of randomized controlled trials

“…Ablation therapy by percutaneous ethanol injection has been proved effective for HCC when the tumors are small and limited in number, and survival rates are similar to those obtained with surgery. [9][10][11] Although liver resection or tumor ablation may provide a potentially curative outcome for HCC patients who are suitable for this procedure, recurrence after resection or ablation is very common. Resection and local ablation of HCC are burdened by a recurrence rate of 50% at 3 years 12 and poor prognosis of HCC patients may result from the high incidence of tumor recurrence.…”