Treatment Outcomes of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma that Invades Hepatic Vein or Inferior Vena Cava

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. 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. 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 a parts per thousand yen50 % 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. 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.