Patients

This is a retrospective case-control study approved by the local institutional review board. Inclusion criteria were: i) unresectable HCC (due to nodule location, presence of portal hypertension, age >75 years, or comorbidities) or refusal of surgery; (ii) solitary HCC ≥40 mm; (iii) BCLC stage A or B; (iv) Child–Pugh class A or B cirrhosis; (v) platelet count > 40 000/μL and INR <2.0; and (vi) no history of previous HCC treatment. Exclusion criteria included: (i) history of encephalopathy or refractory ascites; (ii) vascular invasion or extrahepatic metastasis; (iii) severe comorbidities reducing life expectancy; (iv) BCLC stage C or D; (v) Child–Pugh class C cirrhosis.

Between January 2009 and December 2012, a total of 432 naïve HCC cirrhotic patients were consecutively observed at the Liver Unit of Cardarelli Hospital, Naples, Italy. Among them, 41 consecutive cirrhotic patients with a single HCC nodule ≥ 4.0 mm in diameter met the entry criteria and were enrolled into the study. All 41 patients were treated with LA treatment.

The control group was obtained from the Italian Liver Cancer (ITA.LI.CA.) database [29] and was represented by 41 patients who met the same inclusion and exclusion criteria undergoing a TACE treatment within the same time-frame.

The diagnosis of HCC was based on the European Association for the study of the Liver (EASL) guidelines for HCC management [22]. The patients were classified according to Barcelona Clinic Liver Cancer (BCLC) Staging System [30]. The size and number of the HCC lesions and their location in the liver were established by ultrasound and contrast enhanced Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). In particular, for both diagnostic work-up and follow-up, CT scan and MRI were considered equally given the large size of the nodules [31]. Portal hypertension was defined according to the EASL guidelines.