Does the choice of treatment influence survival of patients with small hepatocellular carcinoma in compensated cirrhosis?
OBJECTIVE
Untreated patients with small, single hepatocellular carcinoma (HCC) in compensated cirrhosis are characterized by a relatively good prognosis.


METHODS
We report the findings generated in a retrospective study on a cohort of 186 consecutive patients with small (< 5 cm) HCC in Child A or B cirrhosis, who were transplanted (four), underwent surgery (15), or were treated with percutaneous ethanol injection (117), lipiodol chemoembolization (44) or best supportive care (six), depending on their clinical features.


RESULTS
Overall survival was 26% at 5 years (31% Child A, 20% Child B), with a mean and median survival of 44 and 38 months, respectively. The longest survival was obtained with transplantation and surgery, and the worst with best supportive care. When untreated patients were not considered, no significant differences were observed between the different types of treatment, however, even when patients in the Child A group were considered alone. Almost all the patients who underwent surgery relapsed. No significant difference was observed in relation to the stage of the disease, while alpha-fetoprotein levels were singled out as the only relevant prognostic factor in a multivariate Cox's regression model. Costs per year of life saved were extremely high for transplantation and lowest for ethanol injection, with surgery being less expensive than chemoembolization.


CONCLUSIONS
This study confirms that patients with single, small HCC nodules in well compensated cirrhosis should be treated. The choice of type of treatment should be based on the availability of local resources and expertise, and on the patients' preference, after they have been properly informed on the survival, morbidity and mortality related to each treatment option. The relative cost of the procedures should also be considered.
Farinati
F
F
Cattedra di Gastroenterologia - Sezione di Gastroenterologia, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico Universitario, Padova, Italy. fabio.farinati@unipol.it
Gianni
S
S
Marin
G
G
Fagiuoli
S
S
Rinaldi
M
M
Naccarato
R
R
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000191:economics / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007459:Iodized Oil / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D008113:Liver Neoplasms / Q000097:blood / Q000191:economics / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D000509:alpha-Fetoproteins / Q000378:metabolism
D000509:alpha-Fetoproteins; D000431:Ethanol; D007459:Iodized Oil