Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 western patients

Background. Percutaneous ethanol injection (PEI) has been used in the Far East for treating small, unresectable hepatocellular carcinoma (HCC). To clarify when treatment with PEI may be best indicated for Western patients with HCC, the authors performed a retrospective analysis of the clinicopathologic factors influencing prognosis. Methods. From December 1987 to August 1994, 105 patients with cirrhosis with HCC received PEI as the sole anticancer treatment. Eighty‐two patients had uninodular tumors smaller than 5 cm, and 23 patients had multiple lesions (2–4) smaller than or equal to 3 cm each. All patients were in Child‐Pugh class A (n = 64) or B (n = 41). Survival was analyzed according to patient‐ and tumor‐related factors by means of the Kaplan‐Meier method. Results. The estimated survival rates of all 105 patients were 96% at 1 year, 86% at 2 years, 68% at 3 years, 51% at 4 years, 32% at 5 years, and 24% at 6 years. Survival was not affected by sex, age, etiology of cirrhosis, or hepatitis B surface antigen or anti‐hepatitis C virus positivity, but depended on Child‐Pugh class (P = 0.006) and presence of ascites (P = 0.009). Patients with a pretreatment alpha‐fetoprotein level of 200 ng/ml or less had a better prognosis than patients with an alpha‐fetoprotein level higher than 200 ng/ml (P = 0.007). Patients with uninodular HCC of 3 cm or less had significantly better long term survival (P = 0.04) than patients with uninodular HCC of 3.1‐5 cm or with multinodular tumors. Tumor grade according to Edmondson and Steiner¹ and tumor volume, in contrast, did not significantly influence prognosis (P > 0.1). Conclusions. For Western patients with HCC treated with PEI, the prognosis was highly dependent on the severity of the underlying cirrhosis. Treatment with PEI is best indicated for patients with uninodular tumors of 3 cm or less in greatest dimension and an alpha‐fetoprotein level lower than 200 ng/ml. Cancer 1995; 76:1737–46.