Survival of Patients With Early Hepatocellular Carcinoma Treated by Percutaneous

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From Alimentary Pharmacology & Therapeutics

FULL TEXT AT: http://www.medscape.com/viewarticle/529576?src=mp

Survival of Patients With Early Hepatocellular Carcinoma Treated by

Percutaneous Alcohol Injection

Posted 04/21/2006

A. Andriulli; I. De Sio; F. Brunello; A. Salmi; L. Solmi; D. Facciorusso; E.

Caturelli; F. Perri

Summary and Introduction

Summary

Background: Once small (<10 mm) nodules, suspicious for hepatocellular

carcinoma, are detected in cirrhotics, the European Association for the

Study of the Liver guidelines recommend to delay histological confirmation

and treatment until they increase in size.

Aim: To validate this policy by evaluating survival of 450 cirrhotics in

Child-Pugh class A or B with unifocal 'early' hepatocellular carcinoma

treated by percutaneous alcohol injection.

Methods: Patients were sorted by nodular size into three groups: & #8804;10

mm (n = 36, group A), >10 to & #8804;20 mm (n = 142, group and >20 to

& #8804;30 mm (n = 272, group C). Overall and tumour-free survivals were

estimated by Kaplan–Meier method.

Results: In groups A, B and C, mean follow-up was 33 ± 26, 34 ± 22 and 35 ±

25 months (P = 0.89), mean survival time was 63 ± 54, 57 ± 48 and 62 ± 66

months (P = 0.69) and mean tumour-free survival was 44 ± 47, 46 ± 58 and 41

± 68 months (P = 0.51), respectively. When patients were sorted by Child

status, mean survival time was 76 ± 82 and 38 ± 29 months in Child A and B

(P < 0.0001).

Conclusions: The comparable survival of percutaneous alcohol

injection-treated patients with single, early hepatocellular carcinoma

sorted by nodular size supports the European Association for the Study of

the Liver 'wait-and-see' policy for patients with lesions <10 mm, and

suggests that allowing the nodules to grow prior to taking further

diagnostic or therapeutic actions would not harm these patients.

Introduction

Surveillance of cirrhotic patients with serum & #945;-fetoprotein (AFP)

evaluation and ultrasound (US) examination is capable of identifying

hepatocellular carcinoma (HCC) at an early stage and to improve survival of

patients.[1, 2] Once a small ( & #8804;10 mm) suspicious lesion is identified,

further diagnostic work-up is controversial. Common practice is to require a

fine-needle biopsy (FNB) for all nodules, regardless of their size, as more

than 66% of lesions are histologically identifiable as HCC;[3-6] in the

event of a negative result, a repeat biopsy assures diagnosis in as much as

30% of cases.[7, 8] At odds with this practice, the 2000 Conference on

Clinical Management of HCC promoted by the European Association for the

Study of the Liver (EASL)[9] suggested to delay FNB for <10 mm nodules

because of its low diagnostic accuracy at this stage, to biopsy nodules <20

mm as current imaging techniques lack accuracy in distinguishing HCC from

other benign or malignant condition, and to characterize non-invasively

nodules >20 mm because imaging techniques may confidently establish the

diagnosis without performing a FNB.

The debate on the need of liver biopsy in the work-up of small hepatic

lesions has to incorporate outcome data, as the benefits of screening and

prompt diagnosis should be translated into a clear-cut survival advantage.

In the event that size of nodules matters for patients survival, any effort

should be pursued to diagnose a suspicious lesion as small as possible;

conversely, whether the opposite would come true, then the 'wait and see'

policy, advocated by EASL for very small (<10 mm) lesions, would seem

reasonable. Before publication of the EASL guidelines, the Italian

Association for the Study of Liver Diseases recommended histological

evaluation of all suspicious nodules detected in a pre-existing cirrhotic

liver.[10] Taking advantage of this practice, we used a large series of

patients with early HCC & #8804;30 mm to evaluate overall survival of

patients in relation to size of nodules.

--------------------------------------------------------------------------------

A. Andriulli,* I. De Sio,† F. Brunello,‡ A. Salmi,§ L. Solmi,¶ D.

Facciorusso,* E. Caturelli,** & F. Perri,*

*Department of Gastroenterology, 'Casa Sollievo della Sofferenza' Hospital,

IRCCS, San Giovanni Rotondo; †Gastroenterology Unit, Ultrasonography

Section, University Hospital, Naples; ‡Gastroenterology and Digestive

Endoscopy, 'San Giovanni Battista' University Hospital, Turin;

§Gastroenterology Unit, 'S. Orsola – Fatebenefratelli' Hospital, Brescia;

¶Gastroenterology and Digestive Endoscopy, 'S. Orsola-Malpighi' University

Hospital, Bologna; **Gastroenterology Unit, 'Belcolle' Hospital, Viterbo,

Italy

Aliment Pharmacol Ther. 2006;23(9):1329-1335

_________________________________________________________________

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[Guest guest]

From Alimentary Pharmacology & Therapeutics

FULL TEXT AT: http://www.medscape.com/viewarticle/529576?src=mp

Survival of Patients With Early Hepatocellular Carcinoma Treated by

Percutaneous Alcohol Injection

Posted 04/21/2006

A. Andriulli; I. De Sio; F. Brunello; A. Salmi; L. Solmi; D. Facciorusso; E.

Caturelli; F. Perri

Summary and Introduction

Summary

Background: Once small (<10 mm) nodules, suspicious for hepatocellular

carcinoma, are detected in cirrhotics, the European Association for the

Study of the Liver guidelines recommend to delay histological confirmation

and treatment until they increase in size.

Aim: To validate this policy by evaluating survival of 450 cirrhotics in

Child-Pugh class A or B with unifocal 'early' hepatocellular carcinoma

treated by percutaneous alcohol injection.

Methods: Patients were sorted by nodular size into three groups: & #8804;10

mm (n = 36, group A), >10 to & #8804;20 mm (n = 142, group and >20 to

& #8804;30 mm (n = 272, group C). Overall and tumour-free survivals were

estimated by Kaplan–Meier method.

Results: In groups A, B and C, mean follow-up was 33 ± 26, 34 ± 22 and 35 ±

25 months (P = 0.89), mean survival time was 63 ± 54, 57 ± 48 and 62 ± 66

months (P = 0.69) and mean tumour-free survival was 44 ± 47, 46 ± 58 and 41

± 68 months (P = 0.51), respectively. When patients were sorted by Child

status, mean survival time was 76 ± 82 and 38 ± 29 months in Child A and B

(P < 0.0001).

Conclusions: The comparable survival of percutaneous alcohol

injection-treated patients with single, early hepatocellular carcinoma

sorted by nodular size supports the European Association for the Study of

the Liver 'wait-and-see' policy for patients with lesions <10 mm, and

suggests that allowing the nodules to grow prior to taking further

diagnostic or therapeutic actions would not harm these patients.

Introduction

Surveillance of cirrhotic patients with serum & #945;-fetoprotein (AFP)

evaluation and ultrasound (US) examination is capable of identifying

hepatocellular carcinoma (HCC) at an early stage and to improve survival of

patients.[1, 2] Once a small ( & #8804;10 mm) suspicious lesion is identified,

further diagnostic work-up is controversial. Common practice is to require a

fine-needle biopsy (FNB) for all nodules, regardless of their size, as more

than 66% of lesions are histologically identifiable as HCC;[3-6] in the

event of a negative result, a repeat biopsy assures diagnosis in as much as

30% of cases.[7, 8] At odds with this practice, the 2000 Conference on

Clinical Management of HCC promoted by the European Association for the

Study of the Liver (EASL)[9] suggested to delay FNB for <10 mm nodules

because of its low diagnostic accuracy at this stage, to biopsy nodules <20

mm as current imaging techniques lack accuracy in distinguishing HCC from

other benign or malignant condition, and to characterize non-invasively

nodules >20 mm because imaging techniques may confidently establish the

diagnosis without performing a FNB.

The debate on the need of liver biopsy in the work-up of small hepatic

lesions has to incorporate outcome data, as the benefits of screening and

prompt diagnosis should be translated into a clear-cut survival advantage.

In the event that size of nodules matters for patients survival, any effort

should be pursued to diagnose a suspicious lesion as small as possible;

conversely, whether the opposite would come true, then the 'wait and see'

policy, advocated by EASL for very small (<10 mm) lesions, would seem

reasonable. Before publication of the EASL guidelines, the Italian

Association for the Study of Liver Diseases recommended histological

evaluation of all suspicious nodules detected in a pre-existing cirrhotic

liver.[10] Taking advantage of this practice, we used a large series of

patients with early HCC & #8804;30 mm to evaluate overall survival of

patients in relation to size of nodules.

--------------------------------------------------------------------------------

A. Andriulli,* I. De Sio,† F. Brunello,‡ A. Salmi,§ L. Solmi,¶ D.

Facciorusso,* E. Caturelli,** & F. Perri,*

*Department of Gastroenterology, 'Casa Sollievo della Sofferenza' Hospital,

IRCCS, San Giovanni Rotondo; †Gastroenterology Unit, Ultrasonography

Section, University Hospital, Naples; ‡Gastroenterology and Digestive

Endoscopy, 'San Giovanni Battista' University Hospital, Turin;

§Gastroenterology Unit, 'S. Orsola – Fatebenefratelli' Hospital, Brescia;

¶Gastroenterology and Digestive Endoscopy, 'S. Orsola-Malpighi' University

Hospital, Bologna; **Gastroenterology Unit, 'Belcolle' Hospital, Viterbo,

Italy

Aliment Pharmacol Ther. 2006;23(9):1329-1335

_________________________________________________________________

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http://search.msn.click-url.com/go/onm00200636ave/direct/01/

_________________________________________________________________

On the road to retirement? Check out MSN Life Events for advice on how to

get there! http://lifeevents.msn.com/category.aspx?cid=Retirement

[Guest guest]

From Alimentary Pharmacology & Therapeutics

FULL TEXT AT: http://www.medscape.com/viewarticle/529576?src=mp

Survival of Patients With Early Hepatocellular Carcinoma Treated by

Percutaneous Alcohol Injection

Posted 04/21/2006

A. Andriulli; I. De Sio; F. Brunello; A. Salmi; L. Solmi; D. Facciorusso; E.

Caturelli; F. Perri

Summary and Introduction

Summary

Background: Once small (<10 mm) nodules, suspicious for hepatocellular

carcinoma, are detected in cirrhotics, the European Association for the

Study of the Liver guidelines recommend to delay histological confirmation

and treatment until they increase in size.

Aim: To validate this policy by evaluating survival of 450 cirrhotics in

Child-Pugh class A or B with unifocal 'early' hepatocellular carcinoma

treated by percutaneous alcohol injection.

Methods: Patients were sorted by nodular size into three groups: & #8804;10

mm (n = 36, group A), >10 to & #8804;20 mm (n = 142, group and >20 to

& #8804;30 mm (n = 272, group C). Overall and tumour-free survivals were

estimated by Kaplan–Meier method.

Results: In groups A, B and C, mean follow-up was 33 ± 26, 34 ± 22 and 35 ±

25 months (P = 0.89), mean survival time was 63 ± 54, 57 ± 48 and 62 ± 66

months (P = 0.69) and mean tumour-free survival was 44 ± 47, 46 ± 58 and 41

± 68 months (P = 0.51), respectively. When patients were sorted by Child

status, mean survival time was 76 ± 82 and 38 ± 29 months in Child A and B

(P < 0.0001).

Conclusions: The comparable survival of percutaneous alcohol

injection-treated patients with single, early hepatocellular carcinoma

sorted by nodular size supports the European Association for the Study of

the Liver 'wait-and-see' policy for patients with lesions <10 mm, and

suggests that allowing the nodules to grow prior to taking further

diagnostic or therapeutic actions would not harm these patients.

Introduction

Surveillance of cirrhotic patients with serum & #945;-fetoprotein (AFP)

evaluation and ultrasound (US) examination is capable of identifying

hepatocellular carcinoma (HCC) at an early stage and to improve survival of

patients.[1, 2] Once a small ( & #8804;10 mm) suspicious lesion is identified,

further diagnostic work-up is controversial. Common practice is to require a

fine-needle biopsy (FNB) for all nodules, regardless of their size, as more

than 66% of lesions are histologically identifiable as HCC;[3-6] in the

event of a negative result, a repeat biopsy assures diagnosis in as much as

30% of cases.[7, 8] At odds with this practice, the 2000 Conference on

Clinical Management of HCC promoted by the European Association for the

Study of the Liver (EASL)[9] suggested to delay FNB for <10 mm nodules

because of its low diagnostic accuracy at this stage, to biopsy nodules <20

mm as current imaging techniques lack accuracy in distinguishing HCC from

other benign or malignant condition, and to characterize non-invasively

nodules >20 mm because imaging techniques may confidently establish the

diagnosis without performing a FNB.

The debate on the need of liver biopsy in the work-up of small hepatic

lesions has to incorporate outcome data, as the benefits of screening and

prompt diagnosis should be translated into a clear-cut survival advantage.

In the event that size of nodules matters for patients survival, any effort

should be pursued to diagnose a suspicious lesion as small as possible;

conversely, whether the opposite would come true, then the 'wait and see'

policy, advocated by EASL for very small (<10 mm) lesions, would seem

reasonable. Before publication of the EASL guidelines, the Italian

Association for the Study of Liver Diseases recommended histological

evaluation of all suspicious nodules detected in a pre-existing cirrhotic

liver.[10] Taking advantage of this practice, we used a large series of

patients with early HCC & #8804;30 mm to evaluate overall survival of

patients in relation to size of nodules.

--------------------------------------------------------------------------------

A. Andriulli,* I. De Sio,† F. Brunello,‡ A. Salmi,§ L. Solmi,¶ D.

Facciorusso,* E. Caturelli,** & F. Perri,*

*Department of Gastroenterology, 'Casa Sollievo della Sofferenza' Hospital,

IRCCS, San Giovanni Rotondo; †Gastroenterology Unit, Ultrasonography

Section, University Hospital, Naples; ‡Gastroenterology and Digestive

Endoscopy, 'San Giovanni Battista' University Hospital, Turin;

§Gastroenterology Unit, 'S. Orsola – Fatebenefratelli' Hospital, Brescia;

¶Gastroenterology and Digestive Endoscopy, 'S. Orsola-Malpighi' University

Hospital, Bologna; **Gastroenterology Unit, 'Belcolle' Hospital, Viterbo,

Italy

Aliment Pharmacol Ther. 2006;23(9):1329-1335

_________________________________________________________________

Don’t just search. Find. Check out the new MSN Search!

http://search.msn.click-url.com/go/onm00200636ave/direct/01/

_________________________________________________________________

On the road to retirement? Check out MSN Life Events for advice on how to

get there! http://lifeevents.msn.com/category.aspx?cid=Retirement

[Guest guest]

From Alimentary Pharmacology & Therapeutics

FULL TEXT AT: http://www.medscape.com/viewarticle/529576?src=mp

Survival of Patients With Early Hepatocellular Carcinoma Treated by

Percutaneous Alcohol Injection

Posted 04/21/2006

A. Andriulli; I. De Sio; F. Brunello; A. Salmi; L. Solmi; D. Facciorusso; E.

Caturelli; F. Perri

Summary and Introduction

Summary

Background: Once small (<10 mm) nodules, suspicious for hepatocellular

carcinoma, are detected in cirrhotics, the European Association for the

Study of the Liver guidelines recommend to delay histological confirmation

and treatment until they increase in size.

Aim: To validate this policy by evaluating survival of 450 cirrhotics in

Child-Pugh class A or B with unifocal 'early' hepatocellular carcinoma

treated by percutaneous alcohol injection.

Methods: Patients were sorted by nodular size into three groups: & #8804;10

mm (n = 36, group A), >10 to & #8804;20 mm (n = 142, group and >20 to

& #8804;30 mm (n = 272, group C). Overall and tumour-free survivals were

estimated by Kaplan–Meier method.

Results: In groups A, B and C, mean follow-up was 33 ± 26, 34 ± 22 and 35 ±

25 months (P = 0.89), mean survival time was 63 ± 54, 57 ± 48 and 62 ± 66

months (P = 0.69) and mean tumour-free survival was 44 ± 47, 46 ± 58 and 41

± 68 months (P = 0.51), respectively. When patients were sorted by Child

status, mean survival time was 76 ± 82 and 38 ± 29 months in Child A and B

(P < 0.0001).

Conclusions: The comparable survival of percutaneous alcohol

injection-treated patients with single, early hepatocellular carcinoma

sorted by nodular size supports the European Association for the Study of

the Liver 'wait-and-see' policy for patients with lesions <10 mm, and

suggests that allowing the nodules to grow prior to taking further

diagnostic or therapeutic actions would not harm these patients.

Introduction

Surveillance of cirrhotic patients with serum & #945;-fetoprotein (AFP)

evaluation and ultrasound (US) examination is capable of identifying

hepatocellular carcinoma (HCC) at an early stage and to improve survival of

patients.[1, 2] Once a small ( & #8804;10 mm) suspicious lesion is identified,

further diagnostic work-up is controversial. Common practice is to require a

fine-needle biopsy (FNB) for all nodules, regardless of their size, as more

than 66% of lesions are histologically identifiable as HCC;[3-6] in the

event of a negative result, a repeat biopsy assures diagnosis in as much as

30% of cases.[7, 8] At odds with this practice, the 2000 Conference on

Clinical Management of HCC promoted by the European Association for the

Study of the Liver (EASL)[9] suggested to delay FNB for <10 mm nodules

because of its low diagnostic accuracy at this stage, to biopsy nodules <20

mm as current imaging techniques lack accuracy in distinguishing HCC from

other benign or malignant condition, and to characterize non-invasively

nodules >20 mm because imaging techniques may confidently establish the

diagnosis without performing a FNB.

The debate on the need of liver biopsy in the work-up of small hepatic

lesions has to incorporate outcome data, as the benefits of screening and

prompt diagnosis should be translated into a clear-cut survival advantage.

In the event that size of nodules matters for patients survival, any effort

should be pursued to diagnose a suspicious lesion as small as possible;

conversely, whether the opposite would come true, then the 'wait and see'

policy, advocated by EASL for very small (<10 mm) lesions, would seem

reasonable. Before publication of the EASL guidelines, the Italian

Association for the Study of Liver Diseases recommended histological

evaluation of all suspicious nodules detected in a pre-existing cirrhotic

liver.[10] Taking advantage of this practice, we used a large series of

patients with early HCC & #8804;30 mm to evaluate overall survival of

patients in relation to size of nodules.

--------------------------------------------------------------------------------

A. Andriulli,* I. De Sio,† F. Brunello,‡ A. Salmi,§ L. Solmi,¶ D.

Facciorusso,* E. Caturelli,** & F. Perri,*

*Department of Gastroenterology, 'Casa Sollievo della Sofferenza' Hospital,

IRCCS, San Giovanni Rotondo; †Gastroenterology Unit, Ultrasonography

Section, University Hospital, Naples; ‡Gastroenterology and Digestive

Endoscopy, 'San Giovanni Battista' University Hospital, Turin;

§Gastroenterology Unit, 'S. Orsola – Fatebenefratelli' Hospital, Brescia;

¶Gastroenterology and Digestive Endoscopy, 'S. Orsola-Malpighi' University

Hospital, Bologna; **Gastroenterology Unit, 'Belcolle' Hospital, Viterbo,

Italy

Aliment Pharmacol Ther. 2006;23(9):1329-1335

_________________________________________________________________

Don’t just search. Find. Check out the new MSN Search!

http://search.msn.click-url.com/go/onm00200636ave/direct/01/

_________________________________________________________________

On the road to retirement? Check out MSN Life Events for advice on how to

get there! http://lifeevents.msn.com/category.aspx?cid=Retirement