Abstract
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 percent) or B cirrhosis (males 64.4 percent; HCV+ 68 percent; mean age 67.7yrs) and 548 HCC nodules lesser or equal 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 percent confidence interval [CI], 41.15–52.84). The 1-,2-.3-,4-and 5-year cumulative survival rates were 93 percent, 77 percent, 61 percent, 47 percent, and 34 percent, respectively. The independent predictors of survival turned out to be albumin levels major or equal 3.5g/dL (p=0.002; risk ratio [RR] 1.73, 95 percent CI 1.23–2.43), and tumor diameter lesser 3cm (p=0.002; RR 1.41, 95 percent CI 1.13–1.76). Child's class A patients had a 5-year cumulative survival of 41 percent; these figures increased up to 54 percent with a median time survival of 68 months (95 percent 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.