title: Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis.
abstract: OBJECTIVE
  Percutaneous laser ablation (PLA) has been proposed as an active treatment in patients with hepatocellular carcinoma (HCC). However, large multicenter studies using this technique have not been reported.
  
  
  METHODS
  We retrospectively analyzed treatment and survival parameters of 432 cirrhotic patients with nonsurgical early HCC (single nodule < or = 4 cm or three nodules < or = 3 cm each) who had received PLA in nine Italian centers.
  
  
  RESULTS
  Single tumors were seen in 344 (80%) of 432 patients, and two to three nodules were seen in 88 patients (20%), for a total of 548 tumors. An initial complete response after PLA was observed in 338 patients (78%). Median overall survival time was 47 months (95% CI, 41 to 53 months). The 3- and 5-year cumulative survival rates were 61% and 34%, respectively. In multivariate analysis, independent predictors of survival were serum albumin levels more than 3.5 g/dL (P = .002; risk ratio [RR] = 0.580; 95% CI, 0.409 to 0.821), the achievement of a complete tumor ablation (P = .001; RR = 0.517; 95% CI, 0.346 to 0.771), and age less than 73 years (P < .001; RR = 0.466; 95% CI, 0.320 to 0.681). Child-Turcotte-Pugh class A patients had a 5-year cumulative survival rate of 41%; this figure increased up to 60% with a median survival time of 63 months (95% CI, 48 to 78 months) in patients with tumors < or = 2.0 cm.
  
  
  CONCLUSIONS
  This analysis confirms that a complete tumor ablation results in improved survival in patients with nonsurgical HCC. Ideal candidates for PLA are younger patients with normal serum albumin levels and tumor size < or = 2 cm.
authors.affiliation: Department of Radiology and Diagnostic Imaging and Medical Sciences, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy. claudiomaurizio.pacella@fastwebnet.it
authors.forename: Claudio Maurizio
authors.initials: CM
authors.lastname: Pacella
authors.forename: Giampiero
authors.initials: G
authors.lastname: Francica
authors.forename: Francesca Marta Lilja
authors.initials: FM
authors.lastname: Di Lascio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Arienti
authors.forename: Ettore
authors.initials: E
authors.lastname: Antico
authors.forename: Bruno
authors.initials: B
authors.lastname: Caspani
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Magnolfi
authors.forename: Angelo Salomone
authors.initials: AS
authors.lastname: Megna
authors.forename: Stefano
authors.initials: S
authors.lastname: Pretolani
authors.forename: Renato
authors.initials: R
authors.lastname: Regine
authors.forename: Massimo
authors.initials: M
authors.lastname: Sponza
authors.forename: Roberto
authors.initials: R
authors.lastname: Stasi