Korean J Hepatol.  2007 Sep;13(3):387-395. 10.3350/kjhep.2007.13.3.387.

Clinical Features and Treatment Outcome of Advanced Hepatocellular Carcinoma with Inferior Vena Caval Invasion or Atrial Tumor Thrombus

• Kim SU
• Kim YR
• Kim DY
• Kim JK
• Lee HW
• Kim BK
• Han KH
• Chon CY
• Moon YM
• Ahn SH

• KMID: 760740
• DOI: http://doi.org/10.3350/kjhep.2007.13.3.387

Abstract

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with an extension to the inferior vena cava (IVC) or right atrium is uncommon, and its prognosis remains unclear due to the few case reports. In order to elucidate the natural history and treatment outcome, this study investigated advanced HCC patients with an IVC invasion or atrial tumor thrombus. METHODS: Between November 1987 and June 2004, a total of 41 patients were diagnosed as having HCC with IVC or right atrial involvement using the new imaging techniques including a two-dimensional echocardiography. Those patients were stratified into the untreated 'control group' (n=17) and 'treated group' (n=24). The clinical features, treatment outcome and prognosis including patient survival were analyzed. RESULTS: The mean age of the total patients was 55 years (male:female, 33:8). The most common cause of HCC was a hepatitis B virus infection (85.4%), followed by a hepatitis C virus infection (7.4%). According to the Child-Pugh classification, 24 patients were Child-Pugh class A (58.5%), 15 were Child-Pugh class B (36.6%), and 2 were Child-Pugh class C (4.9%). Lung metastases were identified in 10 patients (24.5%). The treatment modalities of the treated group included 11 systemic chemotherapy regimens (5-FU and cisplatin), 10 transarterial chemotherapy regimens, 2 chemoradiation procedures and 1 hepatic resection. The overall survival was 3.0 months (range, 1-29 months). The 6 month survival rate was 23.5% (4/17) in the control group and 29.2% (7/24) in the treated group. The 12 months survival rate was 0% (0/17) and 25.0% (6/24), respectively. Independent prognostic factor affecting the survival was whether or not any treatment had been carried out. CONCLUSIONS: Although the prognosis of advanced HCC with IVC invasion or a right atrial tumor thrombi is poor, treatment might improve the survival rate.

Keyword

Carcinoma, hepatocellular; Cardiovascular invasion; Treatment outcome; Prognosis; Survival

MeSH Terms

Adolescent
Adult
Aged
Carcinoma, Hepatocellular/mortality/*pathology/*therapy
Combined Modality Therapy
Female
*Heart Atria/pathology
Heart Diseases/*etiology
Humans
Liver Neoplasms/mortality/*pathology/*therapy
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Prognosis
Retrospective Studies
Severity of Illness Index
Survival Analysis
Thrombosis/*etiology
Treatment Outcome
*Vena Cava, Inferior/pathology