Yonsei Med J.  2014 Mar;55(2):379-386.

Risk Factors for Patients with Stage IVB Hepatocellular Carcinoma and Extension into the Heart: Prognostic and Therapeutic Implications

• Jun CH
• Sim DW
• Kim SH
• Hong HJ
• Chung MW
• Cho SB
• Park CH
• Joo YE
• Kim HS
• Choi SK
• Rew JS

Abstract

PURPOSE
To evaluate the risk factors of hepatocellular carcinoma (HCC) extension into the right atrium (RA) and determine poor prognostic factors for HCC extension to the heart.
MATERIALS AND METHODS
A total of 665 patients who were newly diagnosed with HCC were analyzed retrospectively from January 2004 to July 2012. The patients were divided into two groups: 33 patients with HCC extending into the RA and 632 HCC patients during the same period. The patients with HCC extending into the RA were subdivided into shorter survival group (<2 months) and longer survival group (> or =2 months).
RESULTS
The prevalence of HCC extending to the RA was 4.96%. In multivariate analysis, a modified Union Internationale Contre le Cancer (UICC) stage higher than IVA, hepatic vein invasion, concomitant inferior vena cava and portal vein invasion, and multinodular tumor type were risk factors for HCC extending to the RA. In multivariate analysis, Cancer of the Liver Italian Program (CLIP) score >3 (p=0.016, OR: 13.89) and active treatment (p=0.024, OR: 0.054) were associated with prognostic factors in patients HCC extending into the RA. Active treatment such as radiation (n=1), transcatheter arterial chemoembolization (TACE) (n=11), Sorafenib (n=1), and combined modalities (n=2) were performed.
CONCLUSION
Modified UICC stage higher than IVA, vascular invasion and multinodular tumor type are independent risk factors for HCC extending to the RA. Active treatment may prolong survival in patients HCC extending into the RA.

Keyword

Active cancer treatment; hepatocellular carcinoma; metastasis; right atrium; prognosis

MeSH Terms

Carcinoma, Hepatocellular*
Heart Atria
Heart*
Hepatic Veins
Humans
Liver Neoplasms
Methods
Multivariate Analysis
Neoplasm Metastasis
Portal Vein
Prevalence
Prognosis
Retrospective Studies
Risk Factors*
Vena Cava, Inferior

Figure

• 

  Fig. 1 The survival curve of patients with HCC extending into the RA. HCC, hepatocellular carcinoma; RA, right atrium.

• 

  Fig. 2 The survival curves of patients in the supportive care and active treatment groups with HCC and RA invasion (log rank test, p=0.037).

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