TREATMENT OF SMALL HEPATOCELLULAR-CARCINOMA WITH PERCUTANEOUS ETHANOLINJECTION - ANALYSIS OF PROGNOSTIC FACTORS IN 105 WESTERN PATIENTS

Background. Percutaneous ethanol injection (PEI) has been used in the Far East for treating small, unresectable hepatocellular carcinoma (HC C). To clarify when treatment with PEI may be best indicated for Weste rn patients with HCC, the authors performed a retrospective analysis o f the clinicopathologic factors influencing prognosis. Methods. From D ecember 1987 to August 1994, 105 patients with cirrhosis with HCC rece ived PEI as the sole anticancer treatment. Eighty-two patients had uni nodular tumors smaller than 5 cm, and 23 patients had multiple lesions (2-4) smaller than or equal to 3 cm each. All patients were in Child- Pugh class A (n = 64) or B (n = 41). Survival was analyzed according t o patient- and tumor-related factors by means of the Kaplan-Meier meth od. Results. The estimated survival rates of all 105 patients were 96% at 1 year, 86% at 2 years, 68% at 3 years, 51% at 4 years, 32% at 5 y ears, and 24% at 6 years. Survival was not affected by sex, age, etiol ogy of cirrhosis, or hepatitis B surface antigen or anti-hepatitis C v irus positivity, but depended on Child-Pugh class (P = 0.006) and pres ence of ascites (P = 0.009). Patients with a pretreatment alpha-fetopr otein level of 200 ng/ml or less had a better prognosis than patients with an alpha-fetoprotein level higher than 200 ng/ml (P = 0.007). Pat ients with uninodular HCC of 3 cm or less had significantly better lon g term survival (P = 0.04) than patients with uninodular HCC of 3.1-5 cm or with multinodular tumors. Tumor grade according to Edmondson and Steiner(1) and tumor volume, in contrast, did not significantly influ ence prognosis (P > 0.1). Conclusions. For Western patients with HCC t reated with PEI, the prognosis was highly dependent on the severity of the underlying cirrhosis. Treatment with PEI is best indicated for pa tients with uninodular tumors of 3 cm or less in greatest dimension an d an alpha-fetoprotein level lower than 200 ng/ml.