***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To compare the results of percutaneous local ablative therapy ( PLAT ) with surgical resection in the treatment of solitary and small hepatocellular carcinoma ( HCC ) . Summary Background Data : PLAT is effective in small HCC . Whether it is as effective as surgical resection in the long-term survivals remains unknown . Methods : We conducted a prospect i ve r and omized trial on 180 patients with a solitary HCC ≦5 cm to receive either PLAT or surgical resection .  The patients were regularly followed up after treatment with physical examination , blood , and radiologic tests . Results : Of the 90 patients who were r and omized to PLAT , only 71 received PLAT because 19 withdrew their consent . Of the 90 patients who were r and omized to surgical resection , a single Couinaud liver segment resection was carried out in 69 patients , 2 segments in 16 patients , and 3 or more segments in 3 patients . Ethanol injection was given during open surgery in 2 patients . Only 1 patient died after surgical resection within the same hospital admission . Posttreatment complications were more often and severe after surgery than PLAT . The 1- , 2- , 3- , and 4-year overall survival rates  after PLAT and surgery were 95.8 % , 82.1 % , 71.4 % , 67.9 % and 93.3 % , 82.3 % , 73.4 % , 64.0 % , respectively . The corresponding disease-free survival rates were 85.9 % , 69.3 % , 64.1 % , 46.4 % and 86.6 % , 76.8 % , 69 % , 51.6 % , respectively . Statistically , there was no difference between these 2 treatments . Conclusion : PLAT was as effective as surgical resection in the treatment of solitary and small HCC . PLAT had the advantage over surgical resection in being less invasive OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials To assess whether ultrasound‐guided percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small hepatocellular carcinoma ( HCC ) , 60 patients with one to four HCCs smaller than 3 cm were entered onto a r and omized controlled trial . Thirty‐one and 29 patients , respectively , were treated by percutaneous acetic acid injection using 50 % acetic acid or by percutaneous ethanol injection using absolute ethanol . There were no significant differences in age , sex ratio , Child‐Pugh class , size of tumors , or number of tumors between the two groups . When there was no evidence of viable HCC from biopsy , plain and helical dynamic computed tomography , or angiography , the treatment was considered successful and was discontinued . All original tumors were treated successfully by either therapy . However , 8 % of 38 tumors treated with percutaneous acetic acid injection and 37 % of 35 tumors treated with percutaneous ethanol injection  developed a local recurrence ( P < .001 ) during the follow‐up periods of 29 ± 8 months and 23 ± 10 months , respectively . The 1‐ and 2‐year survival rates were 100 % and 92 % in percutaneous acetic acid injection and 83 % and 63 % in percutaneous ethanol injection ( P = .0017 ) . A multivariate analysis of prognostic factors revealed that treatment was an independent predictor of survival . The risk ratio of percutaneous acetic acid injection versus percutaneous ethanol injection was 0.120 ( range , 0.027‐0.528;P = .0050 ) . In conclusion , percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small HCC BACKGROUND Postsurgical recurrence of hepatocellular carcinoma ( HCC ) is frequent and fatal . Adoptive immunotherapy is active against HCC . We assessed whether postoperative immunotherapy could lower the frequency of recurrence . METHODS Between 1992 and 1995 , we did a r and omised trial in which 150 patients who had undergone curative resection for HCC were assigned adoptive immunotherapy  ( n=76 ) or  no adjuvant treatment  ( n=74 ) . Autologous lymphocytes activated vitro with recombinant interleukin-2 and antibody to CD3 were infused five times during the first 6 months . Primary endpoints were time to first recurrence and recurrence-free survival and analyses were by intention to treat . FINDINGS 76 patients received 370 ( 97 % ) of 380 scheduled lymphocyte infusions ( mean cell number per patient 7.1x10(10 ) [ SD 2.1 ] ; CD3 and HLA-DR cells 78 % [ 16 ] ) , and none had grade 3 or 4 adverse events . After a median follow-up of 4.4 years ( range 0.2 - 6.7 ) , adoptive immunotherapy decreased the frequency of recurrence by 18 % compared with controls ( 45 [ 59 % ] vs 57 [ 77 % ] ) [ corrected ] patients . Time to first recurrence in the immunotherapy group was significantly longer than that in the control group ( 48 % [ 37 - 59 ] vs 33 % [ 22 - 43 ] at 3 years , 38 % [ 22 - 54 ] vs 22 % [ 11 - 34 ] at 5 years ; p=0.008 ) . The immunotherapy group had significantly longer recurrence-free survival ( p=0.01 ) and disease-specific survival ( p=0.04 ) than the control group . Overall survival did not differ significantly between groups ( p=0.09 ) . INTERPRETATION Adoptive immunotherapy is a safe , feasible treatment that can lower recurrence and improve recurrence-free outcomes after surgery for HCC Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . BACKGROUND There is no st and ard treatment for unresectable hepatocellular carcinoma .  Arterial embolisation is widely used , but evidence of survival benefits is lacking . METHODS We did a r and omised controlled trial in patients with unresectable hepatocellular carcinoma not suitable for curative treatment , of Child-Pugh class A or B and Okuda stage I or II , to assess the survival benefits of regularly repeated arterial embolisation ( gelatin sponge ) or chemoembolisation ( gelatin sponge plus doxorubicin ) compared with conservative treatment .  903 patients were assessed , and 112 ( 12 % ) patients were finally included in the study . The primary endpoint was survival . Analyses were by intention to treat . FINDINGS The trial was stopped when the ninth sequential inspection showed that chemoembolisation had survival benefits compared with conservative treatment ( hazard ratio of death 0.47 [ 95 % CI 0.25 - 0.91 ] , p=0.025 ) . 25 of 37 patients assigned embolisation , 21 of 40 assigned chemoembolisation , and 25 of 35 assigned conservative treatment  died . Survival probabilities at 1 year and 2 years were 75 % and 50 % for embolisation ; 82 % and 63 % for chemoembolisation , and 63 % and 27 % for control ( chemoembolisation vs control p=0.009 ) . Chemoembolisation induced objective responses sustained for at least 6 months in 35 % (14)of cases , and was associated with a significantly lower rate of portal-vein invasion than conservative treatment . Treatment allocation was the only variable independently related to survival ( odds ratio 0.45 [ 95 % CI 0.25 - 0.81 ] , p=0.02 ) . INTERPRETATION Chemoembolisation improved survival of stringently selected patients with unresectable hepatocellular carcinoma To assess the efficacy of ultrasound-guided percutaneous acetic acid ( 15 % , 20 % , 30 % , 40 % , and 50 % in concentration ) injection for a large nodular hepatocellular carcinoma ( HCC ) , percutaneous acetic acid injection was performed using 15 % to 50 % acetic acid in 28 patients who had one single nodular HCC larger than 3 cm or one main tumor with fewer than two HCCs smaller than 3 cm during the past 7.5 years ; the main tumor was slightly hypervascular in nine patients and was highly hypervascular , showing viable cancer cells despite transcatheter arterial embolization in 19 patients . During the series of treatment sessions for each patient , the same concentration of acetic acid was used . Eight ( 89 % ) of nine slightly hypervascular main tumors , 18 ( 95 % ) of 19 highly hypervascular main tumors , and all 14 small tumors were treated successfully . No serious complications occurred as a direct sequela to acetic acid injection . The 1- , 2- and 3-year recurrence rate from the original main tumor was 0 % , 20 % , and 20 % , respectively , in patients treated with percutaneous acetic acid injection alone and 12 % , 24 % , and 24 % in patients treated with percutaneous acetic acid injection after transcatheter arterial embolization ( P = NS ) . The 1- , 2- , 3- , 4- , and 5-year survival rates were 100 % , 80 % , 80 % , 80 % , and 0 % , respectively , in the former and 90 % , 81 % , 81 % , 61 % , and 61 % in the latter ( P = NS ) . Percutaneous acetic acid injection ( 15 % to 50 % ) may be an effective therapy for slightly hypervascular nodular HCCs larger than 3 cm and highly hypervascular nodular HCCs larger than 3 cm that remain partly viable after transcatheter arterial embolization OBJECTIVE Using a large single-institution experience at a Western referral center , the authors examine partial hepatectomy as treatment of hepatocellular carcinoma and relate treatment outcomes to clinical parameters , including the etiology of underlying cirrhosis . METHODS Four hundred and twelve patients seen between December 1991 and January 1998 were identified in a prospect i ve data base . Data about the surgical procedure , perioperative complications , and long-term outcome were examined . RESULTS One hundred twenty-six patients did not have underlying cirrhosis . Of the 286 patients with cirrhosis , 119 were the result of hepatitis B , 39 hepatitis C , 36 both B and C , 43 ethanol abuse , and the remainder other causes . Two hundred forty-three patients underwent surgical exploration , and 154 patients underwent hepatic resection .  Seven ( 4.5 % ) died from the surgery . One hundred forty-three patients were treated by ablative methods . Patients with cirrhosis had smaller tumors but nevertheless had a lower resectability rate . Neither the presence of cirrhosis nor the etiology of the cirrhosis altered the perioperative morbidity or mortality rate . The greatest determinant of long-term outcome was resectability . The size of the lesion , an alpha-fetoprotein level > 2000 ng/ml , and vascular invasion were also determinants of poor outcome . The presence of cirrhosis was a detrimental factor when analysis was stratified for size of tumor . The cause of cirrhosis did not influence the long-term outcome . The 5-year surv 
    Output:
    
There are no r and omised clinical trials comparing surgical resection and liver transplantation for hepatocellular carcinoma treatment