Analysis of factors predicting survival in patients with hepatocellular carcinoma treated with percutaneous laser ablation.

Abstract

BACKGROUND/AIMS:

The factors which predict the long-term outcome in patients with hepatocellular carcinoma who are treated with percutaneous laser ablation (PLA) are not well established.

METHODS:

We prospectively analyzed treatment and survival parameters of 148 cirrhotic patients with nonsurgical hepatocellular carcinoma who had undergone PLA at a single institution during an 11-year period.

RESULTS:

Single tumors were seen in 129 of 148 (87%) patients, and 2-3 nodules were seen in 19 (13%) patients, for a total of 169 tumors. The median overall time survival was 39 months (95% confidence interval [CI], 30-47 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 89, 75, 52, 43, and 27%, respectively. From multiple regression analysis, the independent predictors of survival were found to be tumor grading (P=0.002; risk ratio [RR] 0.37, 95% CI 0.20-0.70), bilirubin levels < or =2.5mg/dl (P=0.014; RR 1.58, 95% CI 1.09-2.28), and the achievement of complete tumor ablation (P=0.020; RR 0.53, 95% CI 0.31-0.90). An initial complete tumor ablation was the only factor associated with longer survival in patients with Child-Turcotte-Pugh class A cirrhosis (P=0.012; hazard ratio [HR] 0.48, 95% CI 0.23-1.03).

CONCLUSIONS:

A complete tumor ablation results in improved survival in all patients with nonsurgical hepatocellular carcinoma. Ideal candidates for PLA are those with a well-differentiated histology, and normal bilirubin levels.

• Authors: Claudio Maurizio Pacella, Giancarlo Bizzarri, Giampiero Francica, Giuseppe Forlini, Alessandra Petrolati, Dario Valle, Vincenzo Anelli, Antonio Bianchini, Stefano De Nuntis, Sara Pacella, Zaccaria Rossi, John Osborn, Roberto Stasi
• Journal: Journal of hepatology (J Hepatol) Vol. 44 Issue 5 Pg. 902-9 (May 2006) ISSN: 0168-8278 [Print] Netherlands
• PMID: 16545480 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Bilirubin

Topics

• Aged
• Bilirubin (blood)
• Carcinoma, Hepatocellular (mortality, pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Laser Therapy
• Liver Neoplasms (mortality, pathology, surgery)
• Male
• Middle Aged
• Necrosis
• Postoperative Complications (mortality)
• Predictive Value of Tests
• Prospective Studies
• Regression Analysis
• Survival Analysis
• Treatment Outcome