Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis.
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.
Pacella
Claudio Maurizio
CM
Department of Radiology and Diagnostic Imaging and Medical Sciences, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy. claudiomaurizio.pacella@fastwebnet.it
Francica
Giampiero
G
Di Lascio
Francesca Marta Lilja
FM
Arienti
Vincenzo
V
Antico
Ettore
E
Caspani
Bruno
B
Magnolfi
Fabrizio
F
Megna
Angelo Salomone
AS
Pretolani
Stefano
S
Regine
Renato
R
Sponza
Massimo
M
Stasi
Roberto
R