Comparison of Percutaneous Acetic Acid Injection and Percutaneous Ethanol Injection for Hepatocellular Carcinoma in Cirrhotic Patients: A Prospective Study

Background: Ultrasound-guided percutaneous ethanol injection (PEI) and percutaneous acetic acid injection (PAI) are effective in the treatment of hepatocellular carcinoma (HCC). We conducted a prospective study to compare the therapeutic efficacy of both these methods. Methods: Sixty-three patients were treated by PAI using 50% acetic acid and 62 by PEI using pure ethanol. There were no significant baseline differences in age, sex, Child-Pugh class, tumour size and number, or other clinico-biochemical parameters between the two groups. Results: During a follow-up period of 24 ± 9 (range 6-38) months, 19 (30%) of the PAI group and 21 (34%) of the PEI group died ( P &#114 = &#114 0.704). The 1- and 3-year survival rates were 84% and 51% for the PAI group and 81% and 46% for the PEI group ( P &#114 = &#114 0.651). The corresponding tumour recurrence rates were 51% and 74% for the PAI group, and 54% and 64% for the PEI group ( P &#114 = &#114 0.787). The treatment sessions were 3.9 ± 1.6 and 6.2 ± 2.3 for the PAI and PEI groups, respectively, in each treatment cycle ( P &#114 = &#114 0.008). A multivariate analysis using the Cox regression model revealed that ascites (relative risk (RR) 3.1, 95% confidence interval (CI) 1.5-6.3, P &#114 = &#114 0.002), large (>3 &#114 cm) or multinodular HCCs (RR 2.4, 95% CI 1.1-5.4, P &#114 = &#114 0.04), and development of tumour recurrence (RR 7.0, 95% CI 3.1-16.0, P &#114 < &#114 0.001) were independent, poor prognostic factors in both groups. Conclusions: PAI and PEI are equally effective in the treatment of HCC. PAI has the advantage of fewer treatment sessions in each treatment course. Careful pretreatment patient selection may improve survival.