Treatment outcomes of transcatheter arterial chemoembolization for hepatocellular carcinoma that invades hepatic vein or inferior vena cava.

Objective: 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.