For early hepatocellular carcinoma (HCC), surgery, orthotopic liver transplantation (OLT) and percutaneous ethanol injection (PEI) improve the natural history of the disease.
Dr Angelo Andriulli and colleagues performed a retrospective study to evaluate the outcome of patients with cirrhosis and early HCC treated by PEI or OLT.
The researchers included a total of 589 patients with cirrhosis.
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.
The researchers found that the 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.
|The benefit of OLT extends to all patients, regardless of the degree of liver impairment|
In addition, the investigators found that 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 for CTP classes A, B and C respectively.
The research group sorted the patients according to the severity of cirrhosis, and found that mean survival times in PEI and OLT patients were 67 and 80 months in CTP class A, 38 and 90 months in class B, and 31 and 95 months in class C.
Similarly, they found that mean tumor-free survival times in the 2 series of patients were 49 and 98 months in CTP class A, 39 and 121 months in class B, and 35 and 139 months in class C.
Dr Andriulli, speaking on behalf of the group said, "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."