Skip to main content
SpringerLink
Log in

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

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg 211(3):277–287 Epub 1990 Mar 1

    Google Scholar 

  2. Tsuzuki T, Ogata Y, Iida S, Shimazu M (1984) Hepatic resection in 125 patients. Arch Surg 119(9):1025–1032 Epub 1984 Sep 1. PMID: 6089699

    Article  CAS  PubMed  Google Scholar 

  3. Llovet JM, Bustamante J, Castells A et al (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29(1):62–67 Epub 1998 Dec 24. PMID: 9862851

    Article  CAS  PubMed  Google Scholar 

  4. Okada S (2000) How to manage hepatic vein tumour thrombus in hepatocellular carcinoma. J Gastroenterol Hepatol 15(4):346–348 Epub 2000 May 29. PMID: 10824876

    Article  CAS  PubMed  Google Scholar 

  5. Llado L, Virgili J, Figueras J et al (2000) A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer 88(1):50–57 Epub 2000 Jan 5. PMID: 10618605

    Article  CAS  PubMed  Google Scholar 

  6. Jeon SH, Park KS, Kim YH et al (2007) Incidence and risk factors of acute hepatic failure after transcatheter arterial chemoembolization for hepatocellular carcinoma. Korean J Gastroenterol 50(3):176–182 Epub 2007 Sep 22. PMID: 17885283

    PubMed  Google Scholar 

  7. Chern MC, Chuang VP, Cheng T, Lin ZH, Lin YM (2008) Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with inferior vena cava and right atrial tumors. Cardiovasc Intervent Radiol 31(4):735–744 Epub 2008 Apr 23. PMID: 18427894

    Article  CAS  PubMed  Google Scholar 

  8. Kashima Y, Miyazaki M, Ito H et al (1999) Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with extensive tumour thrombus through the hepatic vein. J Gastroenterol Hepatol 14(9):922–927 Epub 1999 Oct 27. PMID: 10535476

    Article  CAS  PubMed  Google Scholar 

  9. Kim HC, Lee JH, Chung JW et al (2013) Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein. J Vasc Interv Radiol 24(2):274–283 Epub 2013 Jan 28. PMID: 23369561

    Article  PubMed  Google Scholar 

  10. Huppertz A, Haraida S, Kraus A et al (2005) Enhancement of focal liver lesions at gadoxetic acid-enhanced MR imaging: correlation with histopathologic findings and spiral CT–initial observations. Radiology 234(2):468–478 Epub 2004 Dec 10. PMID: 15591431

    Article  PubMed  Google Scholar 

  11. Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30(1):52–60 Epub 2010 Feb 19. PMID: 20175033

    Article  CAS  PubMed  Google Scholar 

  12. Koo JE, Kim JH, Lim YS et al (2010) Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys 78(1):180–187 Epub 2009 Nov 18. PMID: 19926229

    Article  PubMed  Google Scholar 

  13. Hou JZ, Zeng ZC, Zhang JY, Fan J, Zhou J, Zeng MS (2012) Influence of tumor thrombus location on the outcome of external-beam radiation therapy in advanced hepatocellular carcinoma with macrovascular invasion. Int J Radiat Oncol Biol Phys 84(2):362–368 Epub 2012 Feb 28. PMID: 22381903

    Article  PubMed  Google Scholar 

  14. Lee YK, Kim SU, Kim do Y et al (2013) Prognostic value of alpha-fetoprotein and des-gamma-carboxy prothrombin responses in patients with hepatocellular carcinoma treated with transarterial chemoembolization. BMC Cancer 13:5 Epub 2013 Jan 4. PMID: 23282286

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Ikai I, Yamaoka Y, Yamamoto Y et al (1998) Surgical intervention for patients with stage IV-A hepatocellular carcinoma without lymph node metastasis: proposal as a standard therapy. Ann Surg 227(3):433–439 Epub 1998 Apr 4. PMID: 9527067

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Kojiro M, Nakahara H, Sugihara S, Murakami T, Nakashima T, Kawasaki H (1984) Hepatocellular carcinoma with intra-atrial tumor growth. A clinicopathologic study of 18 autopsy cases. Arch Pathol Lab Med 108(12):989–992 Epub 198 Dec 1. PMID: 6095786

    CAS  PubMed  Google Scholar 

  17. Lee IJ, Chung JW, Kim HC et al (2009) Extrahepatic collateral artery supply to the tumor thrombi of hepatocellular carcinoma invading inferior vena cava: the prevalence and determinant factors. J Vasc Interv Radiol 20(1):22–29 Epub 2008 Nov 21. PMID: 19026566

    Article  PubMed  Google Scholar 

  18. Izaki K, Sugimoto K, Sugimura K, Hirota S (2004) Transcatheter arterial embolization for advanced tumor thrombus with marked arterioportal or arteriovenous shunt complicating hepatocellular carcinoma. Radiat Med 22(3):155–162 Epub 2004 Aug 4. PMID: 15287530

    PubMed  Google Scholar 

Download references

Conflict of interest

Seong Min Chung, Chang Jin Yoon, Sang Soo Lee, Sukho Hong, Jung Wha Chung, Sung Wook Yang, Nak Jong Seong, Eun Sun Jang, Jin-Wook Kim, and Sook-Hyang Jeong have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea

    Seong Min Chung, Sang Soo Lee, Sukho Hong, Jung Wha Chung, Sung Wook Yang, Eun Sun Jang, Jin-Wook Kim & Sook-Hyang Jeong

  2. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

    Chang Jin Yoon & Nak Jong Seong

Authors
  1. Seong Min Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Jin Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang Soo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sukho Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jung Wha Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sung Wook Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nak Jong Seong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eun Sun Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jin-Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sook-Hyang Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sook-Hyang Jeong.

Additional information

Seong Min Chung and Chang Jin Yoon contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chung, S.M., Yoon, C.J., Lee, S.S. et al. Treatment Outcomes of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma that Invades Hepatic Vein or Inferior Vena Cava. Cardiovasc Intervent Radiol 37, 1507–1515 (2014). https://doi.org/10.1007/s00270-014-0841-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-014-0841-1

Keywords

Search

Navigation