Prognostic factors for survival in patients with compensated cirrhosis andsmall hepatocellular carcinoma after percutaneous ethanol injection therapy

BACKGROUND. The objective of this study was to identify clinical, biochemic al, ultrasound, and/or pathologic parameters capable of predicting survival in a cohort of patients with well compensated cirrhosis and small hepatoce llular carcinoma (HCC) who were treated with percutaneous ethanol injection (PEI). METHODS. The study group included 111 patients with Child-Pugh Class A cirr hosis and with one (93 patients) or two (18 patients) HCC nodules measuring < 5 cm in greatest dimension. All patients underwent multisession PEI. The prognostic values of pretreatment and post-treatment variables were analyz ed using the Kaplan-Meier method. RESULTS. The overall 3-year and 5-year survival rates of 62% and 41%, respe ctively, were not influenced by age, gender, duration of chronic hepatitis, serum albumin, prothrombin time ratio, total bilirubin, <gamma>-glutamyl t ransferase, hepatitis B surface antigen, antihepatitis C virus, HCC size, H CC ultrasound pattern, HCC histologic or cytologic grading, greatest spleen dimension, esophageal varices, or ascites. Levels of alpha -fetoprotein (A FP) > 14 ng/mL (P < 0.006), alanine aminotransferase > 75 IU/L (P < 0.04), and aspartate aminotransferase > 80 IU/L (P < 0.009) and platelet count < 9 2 x 10(9)/L (P < 0.02) before treatment were independent predictors of decr eased survival. Among post-treatment parameters, AFP levels 6 months after PEI > 13.3 ng/mL (P < 0.003) and HCC recurrence in another segment of the l iver (P < 0.04) were linked to decreased survival in univariate analysis. CONCLUSIONS. Among patients with Child-Pugh Class A cirrhosis with small un inodular or binodular HCC who are treated with multisession PEI, those with elevated serum AFP and transaminase levels and low platelet count before t reatment are characterized by decreased survival. During follow-up, intrahe patic recurrence of the tumor is the main factor affecting survival. Cancer 2001;92:126-35. (C) 2001 American Cancer Society.