Korean J Radiol.  2006 Dec;7(4):267-274. 10.3348/kjr.2006.7.4.267.

Risk Factors for Local Tumor Recurrence after Segmental Transarterial Chemoembolization for Hepatocellular Carcinoma: the Importance of Tumor Located in the Segmental Border Zone

• Cho YK
• Chung JW
• Ahn YS
• Park YO
• Kim JK
• Byun JH

• KMID: 1092550
• DOI: http://doi.org/10.3348/kjr.2006.7.4.267

Abstract

OBJECTIVE
We wanted to evaluate whether tumors located in a segmental border zone are predisposed to local recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma. MATERIALS AND METHODS: Seventy-three hepatocellular carcinoma nodules were retrospectively analyzed for local tumor recurrence after performing segmental transarterial chemoembolization by using follow-up CT studies (median follow-up period: 20 months, range: 4-77 months). The tumors were divided into two groups according to whether the lesions were located at the segmental border zone (Group I) or not (Group II). Comparison of the tumor characteristics and chemoembolization methods between the two groups was performed using the chi-square test. The local recurrence rates were compared by Kaplan-Meyer method and analyzed with the log rank test. RESULTS: Local tumor recurrence occurred for 25 hepatocellular carcinoma nodules (42.9%). The follow-up periods, tumor characteristics and chemoembolization methods between Groups l and ll were comparable. The local recurrence rate was 64.0% (16/25) in Group I and 18.8% (9/48) in Group II. The difference was statistically significant on the univariate and multivariate analyses (p = 0.000 for both). CONCLUSION: Tumor location in a segmental border zone was a significant risk factor for local tumor recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma.

Keyword

Liver neoplasms, therapy; chemoembolization

MeSH Terms

Risk Factors
Retrospective Studies
Proportional Hazards Models
Neoplasm Recurrence, Local
Middle Aged
Male
Liver Neoplasms/*pathology/*therapy
Iodized Oil/administration & dosage
Humans
Female
Doxorubicin/administration & dosage
Chi-Square Distribution
*Chemoembolization, Therapeutic
Carcinoma, Hepatocellular/*pathology/*therapy
Aged
Adult

Figure

• 

  Fig. 1 A 73-year-old woman with hepatocellular carcinoma. A. Pre-embolization CT imaging on the arterial phase reveals a well-defined enhanced mass measuring 2.9 cm in segment 8 of the liver (arrowhead). The low density lesion in the left lobe dome area is a benign cystic lesion without any interval change over a year (arrow). B. Pre-embolization CT imaging on the portal venous phase reveals the same mass with heterogeneous contrast enhancement (arrowhead). C. Pre-embolization hepatic angiogram shows the mass with heterogeneous hypervascularity (arrowhead). D. Post-embolization hepatic angiogram shows the mass without evidence of hypervascular tumor staining. Note that the segmental arterial feeder was also completely occluded. E. One-month follow-up CT imaging shows the mass with inhomogeneous iodized oil accumulation (arrowhead). F. Seven-month follow-up CT imaging reveals the mass with shrinkage (arrowhead). No definite evidence of local tumor recurrence was noted.

• 

  Fig. 2 A 70-year-old man with hepatocellular carcinoma. A. Pre-embolization CT imaging on the portal phase reveals a large well-defined mass measuring 5.1 cm in the S5 segment (arrow). Portal and delayed phase CT imaging (not shown) revealed delayed marginal rim enhancement, which is a typical finding of hepatocellular carcinoma. B. Pre-embolization CT imaging on the portal phase at the level of segmental border zone area between segments 5 and 8. Note that the upper portion of the tumor is also seen at this level (arrowheads). Therefore, this tumor was regarded as located in the segmental border zone between S5 and S8. C. Pre-embolization hepatic angiogram shows the mass with hypervascularity (arrowhead). Note the segmental arterial feeder of the tumor (arrowhead). A minor blood supply to the tumor from the adjacent segmental artery was also confirmed (not shown). D. Post-embolization hepatic angiogram reveals no evidence of residual hypervascular tumor staining. Note that the right hepatic artery is completely occluded. E. One-month follow-up CT imaging shows the mass with inhomogeneous iodized oil accumulation at the segmental border zone of S5 and S8 (arrowhead). The high density area within the tumor was also seen on the precontrast CT imaging (not shown here). F. Seven-month follow-up hepatic angiogram reveals the tumor with local recurrence. Note that the original segmental feeders are completely occluded (arrowheads). Chemoembolization was performed for this mass.

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  Fig. 3 Comparison of local tumor recurrence rates between tumors located in segmental border zones (n = 25) and those located inside the hepatic segments (n = 48). Tumors located in segmental border zones showed earlier local tumor recurrence compared to those tumors located inside hepatic segments on the univariate and multivariate analyses with using Kaplan-Meyer estimation and the log rank test (p = 0.000 for both).

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