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Prognostic factors for survival in patients with compensated cirrhosis and small hepatocellular carcinoma after percutaneous ethanol injection therapy
Author(s) -
Pompili Maurizio,
Rapaccini Gian Ludovico,
Covino Marcello,
Pignataro Giulia,
Caturelli Eugenio,
Siena Domenico Angelo,
Villani Maria Rosaria,
Cedrone Augusto,
Gasbarrini Giovanni
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20010701)92:1<126::aid-cncr1300>3.0.co;2-v
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , cirrhosis , ascites , percutaneous ethanol injection , univariate analysis , prothrombin time , multivariate analysis , radiofrequency ablation , ablation
BACKGROUND The objective of this study was to identify clinical, biochemical, ultrasound, and/or pathologic parameters capable of predicting survival in a cohort of patients with well compensated cirrhosis and small hepatocellular carcinoma (HCC) who were treated with percutaneous ethanol injection (PEI). METHODS The study group included 111 patients with Child–Pugh Class A cirrhosis and with one (93 patients) or two (18 patients) HCC nodules measuring < 5 cm in greatest dimension. All patients underwent multisession PEI. The prognostic values of pretreatment and post‐treatment variables were analyzed using the Kaplan–Meier method. RESULTS The overall 3‐year and 5‐year survival rates of 62% and 41%, respectively, were not influenced by age, gender, duration of chronic hepatitis, serum albumin, prothrombin time ratio, total bilirubin, γ‐glutamyl transferase, hepatitis B surface antigen, antihepatitis C virus, HCC size, HCC ultrasound pattern, HCC histologic or cytologic grading, greatest spleen dimension, esophageal varices, or ascites. Levels of α‐fetoprotein (AFP) > 14 ng/mL ( P < 0.006), alanine aminotransferase > 75 IU/L ( P < 0.04), and aspartate aminotransferase > 80 IU/L ( P < 0.009) and platelet count < 92 × 10 9 /L ( P < 0.02) before treatment were independent predictors of decreased survival. Among post‐treatment parameters, AFP levels 6 months after PEI > 13.3 ng/mL ( P < 0.003) and HCC recurrence in another segment of the liver ( P < 0.04) were linked to decreased survival in univariate analysis. CONCLUSIONS Among patients with Child–Pugh Class A cirrhosis with small uninodular or binodular HCC who are treated with multisession PEI, those with elevated serum AFP and transaminase levels and low platelet count before treatment are characterized by decreased survival. During follow‐up, intrahepatic recurrence of the tumor is the main factor affecting survival. Cancer 2001;92:126–35. © 2001 American Cancer Society.