Percutaneous ethanol injection for hepatocellular carcinoma: 20-year outcome and prognostic factors.
BACKGROUND
Ethanol injection is the best-known image-guided percutaneous ablation for hepatocellular carcinoma (HCC) and a well-tolerated, inexpensive procedure with few adverse effects. However, there have been few reports on its long-term results.


OBJECTIVE
We report a 20-year consecutive case series at a tertiary referral centre.


METHODS
We performed 2147 ethanol injection treatments on 685 primary HCC patients and analysed a collected database.


RESULTS
Final computed tomography demonstrated complete ablation of treated tumours in 2108 (98.2%) of the 2147 treatments. With a median follow-up of 51.6 months, 5-, 10- and 20-year survival rates were 49.0% [95% confidence interval (CI) = 45.3-53.0%], 17.9% (95% CI = 15.0-21.2%) and 7.2% (95% CI = 4..5-11.5%) respectively. Multivariate analysis demonstrated that age, Child-Pugh class, tumour size, tumour number and serum alpha-fetoprotein level were significant prognostic factors for survival. Five-, 10- and 20-year local tumour progression rates were 18.2% (95% CI = 15.0-21.4%), 18.4% (95% CI = 15.2-21.6%) and 18.4% (95% CI = 15.2-21.6%) respectively. Five-, 10- and 20-year distant recurrence rates were 53.5% (95% CI = 49.4-57.7%), 60.4 (95% CI = 56.3-64.5%) and 60.8% (95% CI = 56.7-64.9%) respectively. There were 45 complications (2.1%) and two deaths (0.09%).


CONCLUSIONS
Ethanol injection was potentially curative for HCC, resulting in survival for more than 20 years. This study suggests that new ablation therapies will achieve similar or even better long-term results in HCC.
Department of Gastroenterology, University of Tokyo, Tokyo, Japan. sshiina-tky@umin.ac.jp
Shuichiro
S
Shiina
Ryosuke
R
Tateishi
Masatoshi
M
Imamura
Takuma
T
Teratani
Yukihiro
Y
Koike
Shinpei
S
Sato
Shuntaro
S
Obi
Fumihiko
F
Kanai
Naoya
N
Kato
Haruhiko
H
Yoshida
Masao
M
Omata
Kazuhiko
K
Koike
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D018450:Disease Progression; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D000431:Ethanol