Clinical characteristics and treatment outcomes of hepatocellular carcinoma with inferior vena cava/heart invasion.

Abstract

BACKGROUND: The prognosis and treatment outcomes of hepatocellular carcinoma (HCC) with inferior vena cava (IVC)/heart invasion have not been established. This study aimed to investigate the clinical characteristics and treatment outcomes of patients with HCC extending to IVC/heart and ascertained whether active treatment beyond best supportive care (BSC) can prolong overall survival.

PATIENTS AND METHODS: We retrospectively reviewed 50 patients with HCC extending to IVC/heart who were admitted from November 1987 to November 2010. They were stratified into a control group with BSC alone (n=18) and a treated group with active treatment more than BSC (n=32).

RESULTS: The mean age was 56.5 years and male gender predominated (n=39, 78.0%). Treatment modalities in the treated group included systemic chemotherapy using 5-fluorouracil with/without cisplatin (n=10, 31.3%), transarterial chemoembolization (n=8, 25.0%), intra-arterial chemotherapy (n=3, 9.4%), concurrent chemoradiation therapy (n=3, 9.4%), radiation (n=2, 6.2%), surgery (n=1, 3.1%), and of the combination above (n=5, 15.6%). Active treatment more than BSC was the only independent predictor of overall survival and the overall survival of the treated group was significantly better than that of the control group (median 4.0 vs. 2.0 months, p=0.003).

CONCLUSION: The prognosis of HCC with IVC/heart invasion is poor. However, if patients are cautiously selected, active treatment beyond BSC might provide a survival benefit in patients with HCC extending to IVC/heart.