Does the choice of treatment influence survival of patients with small hepatocellular carcinoma in compensated cirrhosis?

Objective Untreated patients with small, single hepatocellular carcinoma (H CC) in compensated cirrhosis are characterized by a relatively good prognos is. Methods We report the findings generated in a retrospective study on a coho rt of 186 consecutive patients with small (<5 cm) HCC in Child A or B cirrh osis, who were transplanted (four), underwent surgery (15), or were treated with percutaneous ethanol injection (117), lipiodol chemoembolization (44) or best supportive care (six), depending on their clinical features. Results Overall survival was 26% at 5 years (31% Child A, 20% Child B), wit h a mean and median survival of 44 and 38 months, respectively. The longest survival was obtained with transplantation and surgery, and the worst with best supportive care. When untreated patients were not considered, no sign ificant differences were observed between the different types of treatment, however, even when patients in the Child A group were considered alone. Al most all the patients who underwent surgery relapsed. No significant differ ence was observed in relation to the stage of the disease, while a-fetoprot ein levels were singled out as the only relevant prognostic factor in a mul tivariate Cox's regression model. Costs per year of life saved were extreme ly high for transplantation and lowest for ethanol injection, with surgery being less expensive than chemoembolization. Conclusions This study confirms that patients with single, small HCC nodule s in well compensated cirrhosis should be treated. The choice of type of tr eatment should be based on the availability of local resources and expertis e, and on the patients' preference, after they have been properly informed on the survival, morbidity and mortality related to each treatment option. The relative cost of the procedures should also be considered. Eur J Gastro enterol Hepatol 13:1217-1224 (C) 2001 Lippincott Williams & Wilkins.