RISK-FACTORS FOR INTRAHEPATIC RECURRENCE OF HEPATOCELLULAR-CARCINOMA IN CIRRHOTIC-PATIENTS TREATED BY PERCUTANEOUS ETHANOL INJECTION

BACKGROUND. Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resect ion or percutaneous ethanol injection (PEI). In this study, certain cl inical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients wi th single HCC < 5 cm treated by PEI. METHODS. After PEI treatment of H CC, the patients were followed for a mean period of 33 +/- 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child-Pugh score, hepatitis B virus sur face antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha-fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the post treatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated. RESULTS. The cu mulative 4-year intrahepatic recurrence rate of HCC was 62%. The log r ank test indicated that, among pretreatment parameters, time from cirr hosis diagnosis >6 years (P = 0.05) and AFP level before PEI of >25 ng /mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P < 0.002). With regard to p osttreatment parameters, an AFP level 1 month after PEI of >13 ng/mL w as shown to be significantly related to tumor recurrence by the log ra nk test (P < 0.0001). CONCLUSIONS. Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow-up program. (C) 1997 Ame rican Cancer Society.