No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. Italian Cooperative HCC Study Group.
OBJECTIVE
This retrospective study was undertaken to obtain information relevant to the therapeutic strategy in single hepatocellular carcinoma associated with Child's A and B cirrhosis.


METHODS
From a total of 1108 consecutive patients with hepatocellular carcinoma, 391 patients with single, small (< or = 5 cm) hepatocellular carcinoma (260 in Child A class and 131 in Child B class) were observed: 120 were treated by surgical resection, 155 by percutaneous ethanol injection and 116 were untreated. The end point of the study was 3-year survival. The log rank test was used to compare survival among the different groups.


RESULTS
In the Child A group the cumulative 3-year survival was 79% for surgery, 71% for percutaneous ethanol injection and 26% for no treatment (p < 0.001 for surgery versus no treatment, p < 0.001 for percutaneous ethanol injection vs no treatment). In patients comparable to the surgical group, i.e. potentially operable, survival was 80% for percutaneous ethanol injection and 30% for no treatment. In the Child B group the 3-year survival was 40% for surgery, 41% for percutaneous ethanol injection and 13% for no treatment (p < 0.01 for surgery vs no treatment and p < 0.001 for percutaneous ethanol injection vs no treatment).


CONCLUSIONS
Surgery and percutaneous ethanol injection improve survival in single hepatocellular carcinoma associated with Child A and B cirrhosis compared to untreated patients in the same Child class. A controlled study to identify factors affecting the choice of treatment is justified.
Livraghi
T
T
Serv. Radiologia, Hospital of Vimercate, Milano, Italy.
Bolondi
L
L
Buscarini
L
L
Cottone
M
M
Mazziotti
A
A
Morabito
A
A
Torzilli
G
G
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
D000431:Ethanol