Survival benefit of cirrhotic patients with hepatocellular carcinoma treated by percutaneous ethanol injection as a salvage therapy.
BACKGROUND
The therapeutic strategy for cirrhotic patients with hepatocellular carcinoma (HCC) who cannot tolerate surgery or transcatheter arterial chemoembolization (TACE) is uncertain. The safety and efficacy of percutaneous ethanol injection (PEI) as a salvage therapy in such patients is not clear.


METHODS
A total of 63 (49 men) HCC patients (mean age 67 +/- 11 years), for whom surgery or TACE was not indicated because of the coexistence of various medical conditions, were enrolled and prospectively studied. Fifty-six (89%) were treated with PEI and 7 were treated with conservative measures. The outcome and the factors that may affect survival were evaluated.


RESULTS
During a mean follow-up period of 16 +/- 9 months, 17 (30%) of the patients treated with PEI and 5 (71%) of those treated with conservative measures died (P = 0.045). A total of 16 patient-related and tumor-related variables that may influence the outcome were analyzed. Survival analysis showed that female gender, small (< or = 3 cm) solitary tumor and PEI were associated with a better prognosis (P < 0.05). When using the Cox proportional hazard model, PEI was the only significant independent factor predicting survival (relative risk: 0.3, 95% confidence interval: 0.11-0.86, P = 0.024). The 1- and 2-year survival rates were 85% and 65% for patients treated with PEI compared to 57% and 29% for conservative measures (P = 0.016).


CONCLUSIONS
PEI may be a treatment option for cirrhotic patients who have HCC and coexisting contraindications that preclude surgery and TACE. Careful pre-treatment patient selection may effectively prolong the survival.
Huo
Teh-Ia
TI
Dept. of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan, Republic of China. tihuo@vghtpe.gov.tw
Huang
Yi-Hsiang
YH
Wu
Jaw-Ching
JC
Lee
Pui-Ching
PC
Chang
Full-Young
FY
Lee
Shou-Dong
SD
D000279:Administration, Cutaneous; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods*; D012494:Sampling Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
D000431:Ethanol