Treatment Outcomes of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma that Invades Hepatic Vein or Inferior Vena Cava

• Published in: Cardiovascular and interventional radiology Vol. 37; no. 6; pp. 1507 - 1515
• Main Authors: Chung, Seong Min, Yoon, Chang Jin, Lee, Sang Soo, Hong, Sukho, Chung, Jung Wha, Yang, Sung Wook, Seong, Nak Jong, Jang, Eun Sun, Kim, Jin-Wook, Jeong, Sook-Hyang
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.12.2014; Springer Nature B.V
• Subjects: Antineoplastic Agents - administration & dosage; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Cardiology; Chemoembolization, Therapeutic - methods; Cisplatin - administration & dosage; Clinical Investigation; Female; Gelatin Sponge, Absorbable - administration & dosage; Hepatic Veins - pathology; Humans; Imaging; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Nuclear Medicine; Radiology; Survival Rate; Treatment Outcome; Ultrasound; Vena Cava, Inferior - pathology; Hepatocellular carcinoma; Tumor thrombus; Hepatic vein; Transcatheter arterial chemoembolization; Inferior vena cava
• ISSN: 0174-1551; 1432-086X; 1432-086X
• DOI: 10.1007/s00270-014-0841-1

Purpose We aimed to elucidate the treatment outcomes of transcatheter arterial chemoembolization (TACE) and survival-associated factors in hepatocellular carcinoma (HCC) patients with hepatic vein (HV) and/or inferior vena cava (IVC) invasion. Methods The subjects were consecutively enrolled, newly diagnosed HCC patients with HV/IVC invasion who underwent TACE ( n  = 62) at the Seoul National University Bundang Hospital from May 2003 to October 2012. Clinical characteristics, treatment responses, overall survival, and survival-related factors were analyzed. Results The mean subject age was 56.6 years, 82.3 % were hepatitis B surface antigen-positive, and 76.2 % were classified as Child-Pugh class A. The tumor volume was ≥50 % of the liver in 64.5 % of patients, and 79, 41.9, and 9.7 % of patients had accompanying portal vein, IVC, and right atrial invasion, respectively. TACE response rates for primary tumors and tumor thrombi in HV or IVC were 55.6 and 13 %, respectively. Median overall survival was 10.9 months (range 0.1–23.0 months). Multivariate analysis showed that Child-Pugh class A (hazard ratio [HR] = 0.31; 95 % confidence interval [CI] 0.14–0.72; p  = 0.007), tumor volume <50 % of liver (HR = 0.31; 95 % CI 0.11–0.83; p  = 0.019), alpha-fetoprotein (AFP) response (HR = 0.28; 95 % CI 0.11–0.69; p  = 0.006), and tumor thrombi treatment response (HR = 0.09; 95 % CI 0.01–0.77; p  = 0.027) were independent survival-related factors. Conclusions TACE seems effective for HCC with HV/IVC invasion, especially in patients with preserved hepatic function, a treatment response for tumor thrombi, and an AFP response.