Among patients undergoing percutaneous laser ablation for treatment of hepatocellular carcinoma,
the best chance of long-term survival appears to be associated with good liver function and smaller size
of the tumors at the start of treatment.

　In a 12-year retrospective study of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser
ablation of the lesions in patients with cirrhosis, researchers identified factors that gave patients the
best chance of long-term survival.

　Researchers observed a rate of survival at 5 years of 56.4% among patients with Child's Class A
hepatocellular cancer and with nodules that were less than 2 cm in diameter, according to investigator
and presenter Claudio Pacella, MD, Head of Radiology, Ospedale Regina Apostolorum, Albano
Laziale, Italy.

　In his oral presentation on November 25 at the 93rd Scientific Assembly and Annual Meeting of the
Radiological Society of North America (RSNA) Dr. Pacella suggested that the outcomes in this group
of patients were good enough to use percutaneous laser ablation as a first-line therapeutic option.

　In reviewing the records form nine centres, Dr. Pacella and colleagues identified 278 men and 154
women who underwent treatment to ablate 548 tumours. In this cohort, 344 patients presented with
one tumour, 60 patients had two tumours, and 28 had three tumours.

　Over the course of the study, there was a 0.7% rate of perioperative mortality.

　About 39% of patients had tumours that were less than 2 cm in diameter, 242 patients or 44% had
tumours that were 2.1 to 3 cm in diameter, and 91 patients had tumours that were 3.1 to 4 cm in
diameter.

　Treatment was successful in destroying 79% of tumours that were less than 4 cm in diameter.

　While univariate analysis identified several possible variables that would account for an improved
chance of long-term survival, multivariate analysis determined that two factors predicted outcome:
albumin level and tumour size no greater than 3 cm in diameter.

　"Selection of patients with good liver function and small-sized hepatocellular carcinoma is the main
factor affecting patients' outcome after ultrasound-guided percutaneous laser ablation," Dr. Pacella said.
"The evidence of albumin levels as predictive factors of survival of cirrhotic patients with
hepatocellular carcinoma stressed the role of liver function as a main determinant of patients' outcome.