Predictors of long-term survival in hepatocellular carcinomas: A longitudinal follow-up of 108 patients with small tumors

Aim: Locoregional treatment [including percutaneous ethanol injection (PEI) therapy and transcatheter arterial chemoembolization (TACE)] provides an alternative treatment for early-diagnosed hepatocellular carcinoma (HCC). However, the long-term survival of patients after locoregional treatments remains unclear. Patients and Methods: A total of 108 patients with small HCC not indicated for surgical hepatic resection were recruited between 1991 and 1999. All patients received first treatment with PEI therapy alone or combined with TACE. We followed-up these patients until the end of 2007. Clinical attributes and biological markers in association with long-term survival were collected. Significant predictors were identified by using proportional hazards regression model. Results: The overall 1-, 3-, 5-, and 10-year cumulative survival of patients with HCC (<5 cm) were 88.8%, 59.4%, 29.4%, and 12.3%, respectively. Child-Pugh status, type of tumor (solitary or multiple), levels of pre-treatment aspartate aminotransferase (AST), and treatment modality were significantly associated with long-term survival after adjustment for age and gender. Child-Pugh B (hazard ration, HR=1.98, 95% confidence interval, CI=1.08-3.60) and higher level of pre-treatment AST (HR=1.91, 95% CI=1.18-3.08) were the two most significant predictors for risk of death from HCC-after adjusting for treatment modality and type of tumor. Conclusion: Child-Pugh score and AST level were demonstrated as the two major predictors for long-term survival in patients with small HCC not indicated for surgical treatment who underwent PEI-alone or combined with TACE. Clinical weights from Child-Pugh score and AST level are very informative for risk stratification and clinical surveillance of patients with small HCC treated by PEI-alone or combined with TACE.