Predictive factors of survival and intrahepatic recurrence of hepatocellular carcinoma in cirrhosis after percutaneous ethanol injection: analysis of 71 patients.

Abstract Background/Aims: This study was undertaken to determine the factors predicting survival and intrahepatic recurrence in hepatocellular carcinoma patients treated with percutaneous ethanol injection. Methods: Seventy-one patients with cirrhosis and hepatocellular carcinoma underwent percutaneous ethanol injection (54 males/17 females; median age 66 years; Child a 54/B 17). Fifty-two patients had a single nodule ≤5 cm and 19 had multiple nodules, up to three, each one ≤4 cm. Follow-up ranged from 2–63 months (median 26). Results: Overall survival rates were 89%, 54% and 24% and new lesions recurrence rates 32%, 73% and 81% at 1, 3 and 5 years, respectively. At univariate analysis, monofocal tumor ( p p p p p p p p p =0.040) and tumor number ( p =0.032) significantly affected survival; stepwise analysis revealed basal α-fetoprotein, tumor number and serum albumin ( p =0.0012) as the best combination predicting survival. No variable reliably predicted recurrence by multivariate analysis. Conclusions: In patients with cirrhosis and hepatocellular carcinoma, treated with percutaneous ethanol injection, survival depends on: the severity of the underlying liver disease, uni/multifocality of the tumor and basal α-fetoprotein. Presence of a tumor capsule is associated with lower recurrence rates. At post-treatment evaluation, both survival and recurrence rates are positively affected by complete tumor necrosis and α-fetoprotein ≤10 ng/ml.