Factors that predict intrahepatic recurrence of hepatocellular carcinoma in 81 patients initially treated by percutaneous ethanol injection

BACKGROUND, In Japan, where liver transplantation has not been used to trea t patients with hepatocellular carcinoma (HCC), percutaneous ethanol inject ion (PEI) has been employed for those with small HCCs that are not amenable to surgical resection. In the current study, the authors evaluated PEI as a treatment for HCC patients by studying recurrence rates and survival afte r treatment. They then examined the clinicopathologic factors that predicte d patterns of local and distant intrahepatic recurrence. METHODS. For 81 patients who underwent PEI as initial therapy between 1990 and 1997, the cumulative recurrence and survival rates and their correlatio ns with 16 clinicopathologic factors were studied using the Kaplan-Meier me thod. RESULTS. The 3-year overall cumulative rates of intrahepatic recurrence and survival were 81% and 84%, respectively. At the end of the observation per iod, intrahepatic recurrence was detected in 56 patients (69%). In 21 (38%) of 56 patients, local recurrences were significantly associated with earli er stages of underlying cirrhosis, decreased indocyanine green retention at 15 minutes (ICG R15), larger tumor size, and histologically advanced tumor grade. Distant intrahepatic recurrence was also significantly associated w ith liver function and ICG R15. CONCLUSIONS, PEI is most effective as the initial treatment for patients wi th well-differentiated HCC when the tumor is less than 15 mm ill greatest d imension. However, local recurrence depends predominantly on the biologic c haracteristics of the tumor, regardless of the efficacy of PEI. Surgical re section of HCC should be considered, especially for patients with mild live r dysfunction. (C) 1999 American Cancer Society.