title: Survival of cirrhotic patients with early hepatocellular carcinoma treated by percutaneous ethanol injection or liver transplantation.
abstract: For "early" hepatocellular carcinoma (HCC), surgery, orthotopic liver transplantation (OLT) and percutaneous ethanol injection (PEI) improve the natural history of the disease. We performed a retrospective study to evaluate the outcome of patients with cirrhosis and early HCC treated by PEI (n = 417) or OLT (n = 172). Overall, 589 patients with cirrhosis were studied. The proportion of patients in Child-Turcotte-Pugh (CTP) classes A, B, and C was 52.5%, 33.6%, and 13.9%, respectively. Most patients (78.9%) had solitary HCC. Overall 5-year and 10-year cumulative survival rates were 36.1% and 15.5% after PEI, and 66.3% and 49.1% after OLT, respectively (P < .0001). Overall 5-year and 10-year cumulative tumor-free survival rates were 25.3% and 18.0% after PEI, and 84.6% and 82.2% after OLT, respectively (P < .0001). When patients were sorted according to the severity of cirrhosis, mean survival times in PEI and OLT patients were 67 and 80 months in CTP class A (P = .05), 38 and 90 months in class B (P < .0001), and 31 and 95 months in class C (P = .0004). Similarly, mean tumor-free survival times in the 2 series of patients were 49 and 98 months in CTP class A (P < .0001), 39 and 121 months in class B (P < .0001), and 35 and 139 months in class C (P < .0001). In conclusion, this study challenges the therapeutic efficacy of PEI for patients with cirrhosis and early HCC, when compared to OLT: the proportion of both long-term survivors and tumor-free survivors was increased by OLT over PEI. The benefit of OLT extends to all patients, regardless of the degree of liver impairment.
authors.affiliation: Department of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy. a.andriulli@operapadrepio.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Andriulli
authors.forename: Ilario
authors.initials: I
authors.lastname: de Sio
authors.forename: Luigi
authors.initials: L
authors.lastname: Solmi
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
authors.forename: Roberto
authors.initials: R
authors.lastname: Troisi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Grasso
authors.forename: Virginia
authors.initials: V
authors.lastname: Festa
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Camillo
authors.initials: C
authors.lastname: Del Vecchio Blanco
authors.forename: Bernard
authors.initials: B
authors.lastname: De Hemptinne
authors.forename: Andrew
authors.initials: A
authors.lastname: Burroughs
authors.forename: Francesco
authors.initials: F
authors.lastname: Perri
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000431:Ethanol