Andriulli A, De Sio I, Brunello F, Salmi A, Solmi L, Facciorusso D, Caturelli E, Perri F
Department of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
Aliment Pharmacol Ther. 2006 May 1;23(9):1329-35. doi: 10.1111/j.1365-2036.2006.02901.x.
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.
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.
Patients were sorted by nodular size into three groups: < or =10 mm (n = 36, group A), >10 to < or = 20 mm (n = 142, group B) and >20 to < or = 30 mm (n = 272, group C). Overall and tumour-free survivals were estimated by Kaplan-Meier method.
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).
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.
一旦在肝硬化患者中检测到怀疑为肝细胞癌的小（<10毫米）结节，欧洲肝脏研究协会指南建议推迟组织学确诊和治疗，直到结节增大。
通过评估450例Child-Pugh A级或B级、经皮酒精注射治疗单灶“早期”肝细胞癌的肝硬化患者的生存率，验证这一策略。
根据结节大小将患者分为三组：≤10毫米（n = 36，A组）、>10至≤20毫米（n = 142，B组）和>20至≤30毫米（n = 272，C组）。采用Kaplan-Meier法估计总生存率和无瘤生存率。
A组、B组和C组的平均随访时间分别为33±26、34±22和35±25个月（P = 0.89），平均生存时间分别为63±54、57±48和62±66个月（P = 0.69），平均无瘤生存时间分别为44±47、46±58和41±68个月（P = 0.51）。按Child分级对患者进行分类时，Child A级和B级的平均生存时间分别为76±82和38±29个月（P < 0.0001）。
按结节大小分类的经皮酒精注射治疗的单发早期肝细胞癌患者的生存率相当，支持欧洲肝脏研究协会对病变<10毫米患者采取的“观察等待”策略，并表明在采取进一步诊断或治疗措施之前让结节生长不会对这些患者造成伤害。
