Ultraschall in Med 2007; 28 - V_1_3
DOI: 10.1055/s-2007-988842

Five-year survival in 432 cirrhotic patients with hepatocellular carcinoma (HCC) ≤4cm treated with us-guided percutaneous laser ablation (PLA): A multicentric study

CM Pacella 1, G Francica 2, G Bizzarri 1, V Arienti 3, F Magnolfi 4, FML Di Lascio 5, B Caspani 6, S Pretolani 3, E Antico 7, R Regine 8, A Salomone Megna 9, M Sponza 10
  • 1Ospedale Regina Apostolorum, Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Albano Laziale, Italy
  • 2Presidio Ospedaliero Camilliani 'S. Maria della Pietà', Unità Operativa di Ecografia, Casoria, Italy
  • 3Ospedale Maggiore, Medicina Interna, Bologna, Italy
  • 4Ospedale S. Donato, Unità di Gastroenterologia, Arezzo, Italy
  • 5Università di Bologna, Scienze Statistiche, Bologna, Italy
  • 6Ospedale S. Giuseppe, Dipartimento di Radiologia, Milano, Italy
  • 7Ospedale Umberto I, Dipartimento di Radiologia, Ancona, Italy
  • 8Ospedale S. Maria delle Grazie, Dipartimento di Radiologia, Pozzuoli, Italy
  • 9Ospedale G. Rummo, Unità Operativa di Ecografia, Benevento, Italy
  • 10Ospedale S. Maria della Misericordia, Dipartimento di Radiologia, Udine, Italy

Purpose: to analyze outcome predictors in cirrhotic patients with HCC tumors enrolled in a multicentric study and treated with PLA.

Methods: this retrospective study included 432 consecutive patients with Child's Class A (58.6%) or B cirrhosis (males 64.4%; HCV+ 68%; mean age 67.7yrs)and 548 HCC nodules ≤4cm (mean diameter 25.6mm). During a 12-year period, all patients underwent US-guided PLA at nine centres where a multiple fibre (up to 4) technique and a Nd:YAG laser operating at a wavelength of 1,064 nm were used. Predictors of survival were identified through logistic regression. Probability curves obtained via the Kaplan-Meier method were compared using the Mantel-Cox test.

Results: Initial complete response was achieved in 67.2% of patients. The median overall time survival was 47 months (95% confidence interval [CI], 41.15–52.84). The 1-,2-.3-,4-and 5-year cumulative survival rates were 93%, 77%, 61%, 47%, and 34%, respectively. The independent predictors of survival turned out to be albumin levels ≥3.5g/dL (p=0.002; risk ratio [RR] 1.73, 95% CI 1.23–2.43), and tumor diameter <3cm (p=0.002; RR 1.41, 95% CI 1.13–1.76). Child's class A patients had a 5-year cumulative survival of 41%; these figures increased up to 54% with a median time survival of 68 months (95% CI, 45.85–90.14) in patients with tumors 2cm or smaller.

Conclusions: selection of patients with good liver function and small-sized HCC nodules are the main factors affecting patients'outcome after US-guided PLA.