Factors predicting complete necrosis rate after ultrasound-guided percutaneous laser thermoablation of small hepatocellular carcinoma tumors in cirrhotic patients: a multivariate analysis.
OBJECTIVE
To assess factors affecting the effectiveness of percutaneous laser ablation (PLA) under ultrasound (US) guidance in terms of complete ablation achievement.


METHODS
The clinical records of 86 hepatocellular carcinoma (HCC) tumors (mean diameter 23.7 mm) in 60 cirrhotic patients (mean age 68.3 years; 36 males; 57 HCV+; 53 Child's class A, seven Child's class B) treated by means of PLA were reviewed. PLA was performed with a continuous-wave Nd:YAG laser by a single operator who positioned two to four 300-microm optic fibers advanced in 21-gauge needles into target lesions under US guidance. Triphasic computed tomography (CT) studies were used to verify treatment effectiveness 1 month after PLA completion. The association between characteristics of the lesion and outcome (complete or incomplete ablation) was evaluated by logistic regression, taking into account the following predictive factors: tumor size, pattern of growth (infiltrating or not) at imaging, location, first diagnosis of HCC (naïve tumors vs. non-naïve tumors), number of sessions (1/ > 1), total delivered energy, and years of treatment in 2001-2002 (first period) vs. 2003-2004 (second period).


RESULTS
Complete ablation was obtained in 62 nodules (72%). Statistically significant predictors of incomplete ablation after the first PLA course at both univariate and multivariate analysis included: infiltrating growth pattern (odds ratio (OR) 12.3, P<0.002), non-naïve tumors (OR 8.7, P<0.001), and first period of treatment (OR 10.3, P<0.002).


CONCLUSIONS
The effectiveness of US-guided PLA for HCC tumors < or =4 cm turned out to be negatively affected by both operator-related (the beginning of the operator's experience with the technique) and tumor-related factors (non-naïve, infiltrating HCC tumors).
Francica
G
G
Unità Operativa di Ecografia ed Ecointerventistica, Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, and Dipartimento di Diagnostica per Immagini, Presidio Ospedaliero Camilliani S. Maria della Pietà, Casoria, Italy. giampierofrancica@tin.it
Iodice
G
G
Delle Cave
M
M
Sarrantonio
R
R
Lapiccirella
G
G
Molese
V
V
Smeraldo
D
D
Scarano
F
F
De Marino
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography