Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 western patients

Abstract

Background. Percutaneous ethanol injection (PEI) has been used in the Far East for treating small, unresectable hepatocellular carcinoma (HCC). To clarify when treatment with PEI may be best indicated for Western patients with HCC, the authors performed a retrospective analysis of the clinicopathologic factors influencing prognosis. Methods. From December 1987 to August 1994, 105 patients with cirrhosis with HCC received PEI as the sole anticancer treatment. Eighty‐two patients had uninodular tumors smaller than 5 cm, and 23 patients had multiple lesions (2–4) smaller than or equal to 3 cm each. All patients were in Child‐Pugh class A (n = 64) or B (n = 41). Survival was analyzed according to patient‐ and tumor‐related factors by means of the Kaplan‐Meier method. Results. The estimated survival rates of all 105 patients were 96% at 1 year, 86% at 2 years, 68% at 3 years, 51% at 4 years, 32% at 5 years, and 24% at 6 years. Survival was not affected by sex, age, etiology of cirrhosis, or hepatitis B surface antigen or anti‐hepatitis C virus positivity, but depended on Child‐Pugh class (P = 0.006) and presence of ascites (P = 0.009). Patients with a pretreatment alpha‐fetoprotein level of 200 ng/ml or less had a better prognosis than patients with an alpha‐fetoprotein level higher than 200 ng/ml (P = 0.007). Patients with uninodular HCC of 3 cm or less had significantly better long term survival (P = 0.04) than patients with uninodular HCC of 3.1‐5 cm or with multinodular tumors. Tumor grade according to Edmondson and Steiner1 and tumor volume, in contrast, did not significantly influence prognosis (P > 0.1). Conclusions. For Western patients with HCC treated with PEI, the prognosis was highly dependent on the severity of the underlying cirrhosis. Treatment with PEI is best indicated for patients with uninodular tumors of 3 cm or less in greatest dimension and an alpha‐fetoprotein level lower than 200 ng/ml. Cancer 1995; 76:1737–46.

Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

“…A threshold AFP value of 200 ng/mL is used based on its specificity of 90%. [34][35][36]38,44 The sensitivity of AFP level at this value ranges between 40% and 60%. [34][35][36]38,44 The sensitivity of U/S in detecting HCC ranges from 55% to 85%.…”

“…[34][35][36]38,44 The sensitivity of AFP level at this value ranges between 40% and 60%. [34][35][36]38,44 The sensitivity of U/S in detecting HCC ranges from 55% to 85%. 34,[45][46][47][48][49]50 U/S has specificity between 90% and 94% in detecting HCC.…”

Current and Future Challenges in the Surgical Treatment of Hepatocellular Carcinoma: A Review

“…Specifically, one category is that of image-guided tumor ablation therapies, which includes chemical ablation (mainly with the percutaneous ethanol injection), and thermal ablation, which can be either hyperthermic, such as radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation, or cryoablation. [44][45][46][47][48] Treatment with percutaneous alcohol injection involves several sessions under the guidance of ultrasound, and although there are no randomized controlled trials, it has been shown to improve the natural history of HCC. 44 Radiofrequency ablation, by causing thermal injury to the tissue through electromagnetic energy deposition, has been shown to offer a survival advantage either alone or in combination with resection.…”

“…[44][45][46][47][48] Treatment with percutaneous alcohol injection involves several sessions under the guidance of ultrasound, and although there are no randomized controlled trials, it has been shown to improve the natural history of HCC. 44 Radiofrequency ablation, by causing thermal injury to the tissue through electromagnetic energy deposition, has been shown to offer a survival advantage either alone or in combination with resection. 45 What is becoming increasingly interesting are the findings that RFA may actually have similar effect to resection as a first-line treatment in patients with early-stage cirrhosis and single lesions ,5 cm.…”

Radiofrequency Ablation for Hepatocellular Carcinoma: Help or Hazard?

“…6,7 Nevertheless, repetitive treatment with close follow-up can achieve a long-term tumoricidal effect. [8][9][10] There has been only limited experience with microwave ablation and this has mainly been in Japan. It has been used for more than a decade as an effective method to achieve long-term control of HCC.…”