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Evidence summaries

Percutaneous Ethanol Injection or Percutaneous Acetic Acid Injection for Early Hepatocellular Carcinoma

Percutaneous ethanol injection (PEI) and percutaneous acetic acid injection (PAI) might possibly not differ regarding benefits and harms in patients with early hepatocellular carcinoma, although the evidence is insufficient. There is also insufficient evidence to determine whether PEI or segmental liver resection is more effective. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 3 studies with a total of 261 subjects. 2 of the trials compared percutaneous ethanol injection (PEI) with percutaneous acetic acid injection (PAI). Overall survival (HR 1.47, 95% CI 0.68 to 3.19) and recurrence-free survival (HR 1.42, 95% CI 0.68 to 2.94) were not significantly different between the two groups. Data on the duration of hospital stay were inconclusive. Data on quality of life were not available. There were only mild adverse events in both treatment modalities.

The other trial compared PEI with surgery. There was no significant difference in overall survival (HR 1.57, 95% CI 0.53 to 4.61) and recurrence-free survival (HR 1.35, 95% CI 0.69 to 2.63). No serious adverse events were reported in the PEI group. Three postoperative deaths occurred in the surgery group.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), by imprecise results (few patients and wide confidence intervals), and by inconsistency (variability in results across studies).

    References

    • Weis S, Franke A, Berg T et al. Percutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma. Cochrane Database Syst Rev 2015;(1):CD006745. [PubMed]

Primary/Secondary Keywords