Percutaneous ethanol injection for small hepatocellular carcinoma: Therapeutic efficacy based on 20-year observation

Background/Aims To evaluate the therapeutic efficacy of percutaneous ethanol injection (PEI) for patients with ≤3 lesions of small (≤3 cm diameter) hepatocellular carcinoma (HCC). Methods PEI was applied to 270 patients with small HCC as the first-line treatment option during a 20-year period. Results (1) There was no treatment-related deaths, and only 2.2% of severe complications; (2) PEI induced a complete response of all HCCs according to CT evaluation performed within one month after the procedure, and the local recurrence rate at 3 years was 10%; (3) the overall 3- and 5-year survival rates after treatment were 81.6 and 60.3%, respectively, but the rates were higher, 87.3 and 78.3%, in Child A patients with a solitary tumor ≤2 cm in diameter; (4) factors significantly influencing survival were liver function (P=0.0033) and serum alpha-fetoprotein level (P=0.0014), and (5) the recurrence rate at remote sites in the liver was lower in patients with HCC ≤2 cm (P=0.0395) and in those with a solitary HCC (P<0.0001) according to Coxʹs proportional hazard model. (6) Radiofrequency ablation would not have been performed in approximately 25% of these patients. Conclusions PEI is considered a reliable treatment for small HCC in terms of safety and efficacy.