Survival of cirrhotic patients with early hepatocellular carcinoma treated by percutaneous ethanol injection or liver transplantation

Angelo Andriulli, Ilario de Sio, Luigi Solmi, Luciano De Carlis, Roberto Troisi, Alessandro Grasso, Virginia Festa, Eugenio Caturelli, Alessandro Giacomoni, Camillo Del Vecchio Blanco, Bernard De Hemptinne, Andrew Burroughs, Francesco Perri

Research output: Contribution to journalArticlepeer-review

Abstract

For "early" hepatocellular carcinoma (HCC), surgery, orthotopic liver transplantation (OLT) and percutaneous ethanol injection (PEI) improve the natural history of the disease. We performed a retrospective study to evaluate the outcome of patients with cirrhosis and early HCC treated by PEI (n = 417) or OLT (n = 172). Overall, 589 patients with cirrhosis were studied. The proportion of patients in Child-Turcotte-Pugh (CTP) classes A, B, and C was 52.5%, 33.6%, and 13.9%, respectively. Most patients (78.9%) had solitary HCC. Overall 5-year and 10-year cumulative survival rates were 36.1% and 15.5% after PEI, and 66.3% and 49.1% after OLT, respectively (P <.0001). Overall 5-year and 10-year cumulative tumor-free survival rates were 25.3% and 18.0% after PEI, and 84.6% and 82.2% after OLT, respectively (P <.0001). When patients were sorted according to the severity of cirrhosis, mean survival times in PEI and OLT patients were 67 and 80 months in CTP class A (P = .05), 38 and 90 months in class B (P <.0001), and 31 and 95 months in class C (P = .0004). Similarly, mean tumor-free survival times in the 2 series of patients were 49 and 98 months in CTP class A (P <.0001), 39 and 121 months in class B (P <.0001), and 35 and 139 months in class C (P <.0001). In conclusion, this study challenges the therapeutic efficacy of PEI for patients with cirrhosis and early HCC, when compared to OLT: the proportion of both long-term survivors and tumor-free survivors was increased by OLT over PEI. The benefit of OLT extends to all patients, regardless of the degree of liver impairment.

Original languageEnglish
Pages (from-to)1355-1363
Number of pages9
JournalLiver Transplantation
Volume10
Issue number11
DOIs
Publication statusPublished - Nov 2004

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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