Percutaneous ethanol injection for hepatocellular carcinoma: 20-year outcome and prognostic factors

Background Ethanol injection is the best-known image-guided percutaneous ablation for hepatocellular carcinoma (HCC) and a well-tolerated, inexpensive procedure with few adverse effects. However, there have been few reports on its long-term results. Aims We report a 20-year consecutive case series at a tertiary referral centre. Methods We performed 2147 ethanol injection treatments on 685 primary HCC patients and analysed a collected database. Results Final computed tomography demonstrated complete ablation of treated tumours in 2108 (98.2%) of the 2147 treatments. With a median follow-up of 51.6 similar to months, 5-, 10- and 20-year survival rates were 49.0% [95% confidence interval (CI)similar to=similar to 45.353.0%], 17.9% (95% CI similar to=similar to 15.021.2%) and 7.2% (95% CI similar to=similar to 4..511.5%) respectively. Multivariate analysis demonstrated that age, ChildPugh class, tumour size, tumour number and serum alpha-fetoprotein level were significant prognostic factors for survival. Five-, 10- and 20-year local tumour progression rates were 18.2% (95% CI similar to=similar to 15.021.4%), 18.4% (95% CI similar to=similar to 15.221.6%) and 18.4% (95% CI similar to=similar to 15.221.6%) respectively. Five-, 10- and 20-year distant recurrence rates were 53.5% (95% CI similar to=similar to 49.457.7%), 60.4 (95% CI similar to=similar to 56.364.5%) and 60.8% (95% CI similar to=similar to 56.764.9%) respectively. There were 45 complications (2.1%) and two deaths (0.09%). Conclusions Ethanol injection was potentially curative for HCC, resulting in survival for more than 20 similar to years. This study suggests that new ablation therapies will achieve similar or even better long-term results in HCC.