Hepatocellular carcinoma with internal mammary artery supply: feasibility and efficacy of transarterial chemoembolization and factors affecting patient prognosis.
OBJECTIVE
To determine technical feasibility, therapeutic efficacies, and identify prognostic factors in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization via the internal mammary artery.


METHODS
From August 1996 to July 2005, the authors identified the internal mammary arteries supplying HCCs in 97 (2.2%) of 4,438 HCC patients. Computed tomography scans and digital subtraction angiography images of these 97 patients were retrospectively reviewed by consensus between two of the authors regarding technical success and clinical outcome. The technical success of internal mammary artery chemoembolization was defined as achievement of catheterization into feeding vessels, delivery of drugs via those vessels, and no residual tumor staining fed by the internal mammary artery. Multivariate Cox proportional hazard regression analysis was performed to enable evaluation of prognostic factors for survival.


RESULTS
Technical success by selective chemoembolization via internal mammary artery was achieved in 53 (55%) of the 97 patients. The clinical responses of the 97 patients were complete remission (n=3), partial remission (n=19), no response (n=65), and no available follow-up image (n=10). Overall cumulative survival rates, calculated from times of internal mammary artery chemoembolization, were 55.9% (at 6 months), 32.5% (at 1 year), 15.4% (at 2 years), and 8.2% (at 3 years). Multivariate analysis showed that tumor multiplicity (single vs multiple nodular or diffuse; P=.013), portal vein thrombosis (P=.004), and the technical success of internal mammary artery chemoembolization (P=.02) each significantly affected survival.


CONCLUSIONS
Although patients with HCC supplied by the internal mammary artery had poor prognosis because of their advanced stage of disease, chemoembolization via the internal mammary artery is possible and worth performing in selective situations.
Kim
Hyo-Cheol
HC
Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
Chung
Jin Wook
JW
Choi
Seung Hong
SH
Yoon
Jung-Hwan
JH
Lee
Hyo-Suk
HS
Jae
Hwan Jun
HJ
Lee
Whal
W
Park
Jae Hyung
JH
D000328:Adult; D000368:Aged; D000792:Angiography; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000628:therapy*; D008297:Male; D008323:Mammary Arteries; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin