Transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma invading the portal veins: therapeutic effects and prognostic factors.
OBJECTIVE
This retrospective study was undertaken to evaluate the therapeutic effects of transcatheter hepatic arterial chemoembolization on hepatocellular carcinoma (HCC) invading the portal veins and to identify prognostic factors.


METHODS
Sixty-one patients underwent chemoembolization. The HCC had invaded the main portal vein in 23 patients, a first-order branch in 25 patients and a second-order branch in 13 patients. The hepatic arteries feeding the tumors were embolized with gelatin sponge after a mixture of iodized oil and anticancer drugs was injected via these vessels. Tumor response was evaluated by measuring tumor sizes on CT images. A reduction in maximum diameter of 25% or more was considered to indicate response to chemoembolization. Significant prognostic factors were identified by univariate and multivariate analyses.


RESULTS
Tumor size was reduced by 25% or more in 26 patients (43%). The 1-, 3- and 5-year survival rates were 42, 11 and 3%, respectively, with mean survival of 15 months in all patients. In the univariate analysis, the following six variables were significantly associated with prognosis: (i) tumor response; (ii) ascites; (iii) accumulation of iodized oil in tumor thrombi; (iv) in main tumors; (v) Okuda classification; and (vi) tumor size. In the multivariate analysis, the first three of these factors showed significantly independent values for patient prognosis.


CONCLUSIONS
Chemoembolization appears to be an effective treatment for HCCs invading the portal venous system. The prognostic factors identified here are expected to be helpful in classifying patients with HCCs invading the portal veins and should serve as useful guidelines for chemoembolization in clinical practice.
Uraki
Junji
J
Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8057, Japan.
Yamakado
Koichiro
K
Nakatsuka
Atsuhiro
A
Takeda
Kan
K
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D007459:Iodized Oil