Korean J Radiol.  2007 Apr;8(2):111-119. 10.3348/kjr.2007.8.2.111.

Local Recurrence of Hepatocellular Carcinoma after Segmental Transarterial Chemoembolization: Risk Estimates Based on Multiple Prognostic Factors

• Park SH
• Cho YK
• Ahn YS
• Park YO
• Kim JK
• Chung JW

• KMID: 1126834
• DOI: http://doi.org/10.3348/kjr.2007.8.2.111

Abstract

OBJECTIVE
To determine the prognostic factors for local recurrence of nodular hepatocellular carcinoma after segmental transarterial chemoembolization. MATERIALS AND METHODS: Seventy-four nodular hepatocellular carcinoma tumors < or = 5 cm were retrospectively analyzed for local recurrence after segmental transarterial chemoembolization using follow-up CT images (median follow-up of 17 months, 4-77 months in range). The tumors were divided into four groups (IA, IB, IIA, and IIB) according to whether the one-month follow-up CT imaging, after segmental transarterial chemoembolization, showed homogeneous (Group I) or inhomogeneous (Group II) iodized oil accumulation, or whether the tumors were located within the liver segment (Group A) or in a segmental border zone (Group B). Comparison of tumor characteristics between Group IA and the other three groups was performed using the chi-square test. Local recurrence rates were compared among the groups using the Kaplan-Meier estimation and log rank test. RESULTS: Local tumor recurrence occurred in 19 hepatocellular carcinoma tumors (25.7%). There were: 28, 18, 17, and 11 tumors in Group IA, IB, IIA, and IIB, respectively. One of 28 (3.6%) tumors in Group IA, and 18 of 46 (39.1%) tumors in the other three groups showed local recurrence. Comparisons between Group IA and the other three groups showed that the tumor characteristics were similar. One-, two-, and three-year estimated local recurrence rates in Group IA were 0%, 11.1%, and 11.1%, respectively. The difference between Group IA and the other three groups was statistically significant (p = 0.000). CONCLUSION: An acceptably low rate of local recurrence was observed for small or intermediate nodular tumors located within the liver segment with homogeneous iodized oil accumulation.

Keyword

Liver neoplasms, therapy; Chemoembolization

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/*pathology/radiography/*therapy
Chemoembolization, Therapeutic/*methods
Chi-Square Distribution
Female
Humans
Iodized Oil/administration & dosage
Liver Neoplasms/*pathology/radiography/*therapy
Male
Middle Aged
Neoplasm Recurrence, Local/radiography
Prognosis
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 A 57-year-old male patient with hepatocellular carcinoma. A. Pre-embolization arterial phase CT image shows a small high density lesion within liver segment 5 (white arrow). Portal phase CT imaging showed washout of the contrast enhancement (not shown). Hepatocellular carcinoma was diagnosed based on the typical CT findings. B. Arterial phase pre-embolization hepatic angiogram reveals the corresponding tumor with hypervascular staining (arrow). C. Post-embolization hepatic angiogram shows no evidence of residual tumor staining. Note that the corresponding segmental artery was occluded. D. One-month follow-up CT imaging, during the arterial phase, shows the mass with iodized oil accumulation (arrow). There was no evidence of a residual enhanced portion within or around the tumor. E. Follow-up CT imaging, during the arterial phase, 29 months after the segmental transarterial chemoembolization, shows the same mass with reduction in size (arrow). There was no evidence of local tumor recurrence.

• 

  Fig. 2 A 61-year-old male patient with hepatocellular carcinoma. A. Pre-embolization arterial phase CT imaging shows a small high density lesion located within the segmental border zone between liver segment 6 and 7 (arrow). Portal phase CT imaging showed washout of the contrast enhancement (not shown). Hepatocellular carcinoma was diagnosed based on the typical CT findings. B. Arterial phase pre-embolization hepatic angiogram reveals the corresponding tumor with hypervascular staining (arrow). The other small hypervascular mass was confirmed as a hemangioma (arrowheads). C. Post-embolization hepatic angiogram shows no evidence of residual tumor staining. Note that the corresponding segmental artery was occluded. D. One-month follow-up CT imaging, during the arterial phase, shows the mass with iodized oil accumulation (arrow). There was no evidence of a residual enhanced portion within or around the tumor. E. Follow-up CT imaging, during the portal phase, four months after the segmental transarterial chemoembolization shows a mass with irregular margin at the same location, highly suggesting local tumor recurrence (arrow). Arterial phase imaging showed subtle contrast enhancement of the lesion (not shown). Hepatic angiogram revealed irregular margined hypervascular tumor staining, and further transarterial chemoembolization was performed.

• 

  Fig. 3 Comparison of local tumor recurrence rates between the four groups. Kaplan-Meier estimation and the log rank test were used. The difference between Group IA and IB and between Group IB and IIB was statistically significant (p = 0.001 and 0.003, respectively). All tumors were the nodular type, and the iodized oil accumulation was evaluated at the one-month follow-up CT imaging after transarterial chemoembolization (Group IA: tumors located within liver segment, with homogeneous iodized oil accumulation within the tumors; Group IB: tumors located in segmental border zone, with homogeneous iodized oil accumulation within the tumors; Group IIA: tumors located within liver segment, with inhomogeneous iodized oil accumulation within the tumors; Group IIB: tumors located in segmental border zone, with inhomogeneous iodized oil accumulation within the tumors).

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