Originally published as JCO Early Release 10.1200/JCO.2008.19.0082 on March 30 2009

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Long-Term Outcome of Cirrhotic Patients With Early Hepatocellular Carcinoma Treated With Ultrasound-Guided Percutaneous Laser Ablation: A Retrospective Analysis

From the Departments of Radiology and Diagnostic Imaging and Medical Sciences, Regina Apostolorum Hospital, Albano Laziale; Internal Medicine, Diagnostic and Interventional Ultrasound Unit, S. Maria della Pietà Hospital, Casoria; Department of Statistics "P. Fortunati," University of Bologna; Department of Internal Medicine, Maggiore Hospital, Bologna; Department of Radiology, University Hospital Umberto I, Ancona; Department of Radiology, S. Giuseppe-Fatebenefratelli Hospital, Milano; Gastroenterology Unit, San Donato Hospital, Arezzo; Department of Infectious Diseases, Diagnostic and Interventional Liver Ultrasound Unit, Rummo Hospital, Benevento; Department of Vascular and Interventional Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Napoli; and Department of Interventional Radiology, S. Maria della Misericordia Hospital, Udine, Italy.

Corresponding author: Claudio M. Pacella, MD, Diagnostic Imaging Department, Regina Apostolorum Hospital, Via San Francesco, 50-00041, Albano Laziale, Rome, Italy; e-mail: claudiomaurizio.pacella{at}fastwebnet.it.

Purpose Percutaneous laser ablation (PLA) has been proposed as an active treatment in patients with hepatocellular carcinoma (HCC). However, large multicenter studies using this technique have not been reported.

Patients and Methods We retrospectively analyzed treatment and survival parameters of 432 cirrhotic patients with nonsurgical early HCC (single nodule 4 cm or three nodules 3 cm each) who had received PLA in nine Italian centers.

Results Single tumors were seen in 344 (80%) of 432 patients, and two to three nodules were seen in 88 patients (20%), for a total of 548 tumors. An initial complete response after PLA was observed in 338 patients (78%). Median overall survival time was 47 months (95% CI, 41 to 53 months). The 3- and 5-year cumulative survival rates were 61% and 34%, respectively. In multivariate analysis, independent predictors of survival were serum albumin levels more than 3.5 g/dL (P = .002; risk ratio [RR] = 0.580; 95% CI, 0.409 to 0.821), the achievement of a complete tumor ablation (P = .001; RR = 0.517; 95% CI, 0.346 to 0.771), and age less than 73 years (P < .001; RR = 0.466; 95% CI, 0.320 to 0.681). Child-Turcotte-Pugh class A patients had a 5-year cumulative survival rate of 41%; this figure increased up to 60% with a median survival time of 63 months (95% CI, 48 to 78 months) in patients with tumors 2.0 cm.

Conclusion This analysis confirms that a complete tumor ablation results in improved survival in patients with nonsurgical HCC. Ideal candidates for PLA are younger patients with normal serum albumin levels and tumor size 2 cm.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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