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