Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma

BACKGROUND. Percutaneous ethanol injection therapy has been used widely for small hepatocellular carcinoma. This study was undertaken to determine fac tors predictive of local recurrence or new nodular recurrence in patients w ith small hepatocellular carcinoma treated with percutaneous ethanol inject ion. METHODS. The authors studied 73 nodules treated with percutaneous ethanol i njection in 49 patients with small hepatocellular carcinoma. The usefulness of predictive factors for recurrence was assessed with the Kaplan-Meier me thod. The clinicopathologic variables examined included age, gender, Child- Pugh classification, number of tumors (single vs, multiple), tumor size, de gree of tumor differentiation, ultrasonographic findings such as peripheral hypoechoic band (so-called 'halo'), intratumoral echo pattern, tumor stain ing on enhanced computed tomography, combination therapy with transcatheter arterial embolization, and serum alpha-fetoprotein level. RESULTS, The local recurrence rates were 19%, 27%, 33%, 33%, and 33%, respe ctively, and the new nodular recurrence rates were 19%, 51%, 74%, 83%, and 83%, respectively, at 1, 2, 3, 4, and 5 years after percutaneous ethanol in jection therapy. The frequency of local recurrence was associated with the histologic differentiation of more than moderately differentiated (P < 0.00 1), presence of a sonographic halo (P < 0.005), an intratumoral heterogeneo us echo pattern (P < 0.001), and positive tumor staining on enhanced comput ed tomography (P < 0.01). Multivariate analysis showed that the presence of a halo and an intratumoral heterogeneous echo pattern were the most import ant variables for predicting local recurrence. The frequency of new nodular recurrences was related to the presence of multiple tumors (P < 0.01) and a high serum alpha-fetoprotein level (P < 0.001). Multivariate analysis sho wed that a high serum alpha-fetoprotein level was a reliable predictor of n ew nodular recurrence. CONCLUSIONS. This study showed that the presence of a halo and an intratumo ral echo pattern on ultrasonography were useful predictors for local recurr ence after percutaneous ethanol injection therapy for small hepatocellular carcinoma, and that a high serum alpha-fetoprotein level was associated wit h a higher frequency of new nodular recurrences. (C) 2000 American Cancer S ociety.