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Transarterial Chemoembolization for Hepatocellular Carcinomas with Central Bile Duct Invasion: Safety, Prognosis, and Predictive Factors

  • Clinical Investigation
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Abstract

Purpose

To assess the safety and effectiveness of transarterial chemoembolization (TACE) of patients who have hepatocellular carcinomas (HCCs) with central bile duct invasion.

Materials and Methods

The institutional review board approved this retrospective study and waived informed consent. Fifty-three patients, initially treated with TACE for HCCs with central bile duct invasion from January 1999 to September 2012, were included. Clinical, laboratory, and survival data were reviewed. Complications and hospitalization length were evaluated using the χ 2 test, Fisher’s exact test, and logistic regression analysis. Survival was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazard model.

Results

Seven patients experienced TACE-related major complications (severe post-embolization syndrome in 3, non-fatal sepsis in 3, and secondary bacterial peritonitis in 1). The overall major complication rate was 13.2 %, but there were no permanent adverse sequelae or deaths within 30 days. Serum total bilirubin ≥3.0 mg/dL was the only significant risk factor for long hospitalization [hazard ratio (HR) = 4.341, p = .022]. The median survival was 12.2 months. Extrahepatic metastasis (HR = 6.145, p < .001), international normalized ratio (PT-INR) ≥1.20 (HR = 4.564, p < .001), vascular invasion (HR = 3.484, p = .001), and intermediate tumor enhancement (HR = 2.417, p = .019) were significantly associated with shorter survival.

Conclusion

TACE can be a safe and effective treatment for patients who have HCCs with central bile duct invasion. In particular, long-term survival can be expected if patients have strongly enhancing tumors without poor prognostic factors such as extrahepatic metastasis, PT-INR prolongation, and vascular invasion.

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Abbreviations

HCC:

Hepatocellular carcinoma

TACE:

Transarterial chemoembolization

CT:

Computed tomography

AASLD:

American Association for the Study of Liver Disease

SD:

Standard deviation

ECOG:

Eastern Cooperative Oncology Group

BCLC:

Barcelona Clinic Liver Cancer

SIR:

Society of Interventional Radiology

PT-INR:

International normalized ratio of prothrombin time

HR:

Hazard ratio

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Conflict of interest

Jin Woo Choi: no conflict of interest; Jin Wook Chung: no conflict of interest; Yun Ku Cho: no conflict of interest; Yoon Jun Kim: no conflict of interest; Jung-Hwan Yoon: no conflict of interest; Hyo-Cheol Kim: no conflict of interest; Hwan Jun Jae: no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea

    Jin Woo Choi, Jin Wook Chung, Hyo-Cheol Kim & Hwan Jun Jae

  2. Department of Radiology, VHS Medical Center, Seoul, Korea

    Yun Ku Cho

  3. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

    Yoon Jun Kim & Jung-Hwan Yoon

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  1. Jin Woo Choi
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  2. Jin Wook Chung
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Correspondence to Jin Wook Chung.

Electronic supplementary material

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Fig. E1. Kaplan–Meier curves of cumulative survival rates after TACE by Child-Pugh class (TIFF 4116 kb)

270_2014_1032_MOESM2_ESM.tif

Fig. E2. Kaplan–Meier curve of cumulative survival rate for patients have strongly enhancing tumors, without extrahepatic metastasis, PT-INR prolongation, and vascular invasion (median survival, 78.9 months) (TIFF 2624 kb)

270_2014_1032_MOESM3_ESM.tif

Fig. E3. Kaplan–Meier curve showing cumulative survival rate of patients who underwent surgical resection after 1–5 sessions of TACE (TIFF 2612 kb)

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Choi, J.W., Chung, J.W., Cho, Y.K. et al. Transarterial Chemoembolization for Hepatocellular Carcinomas with Central Bile Duct Invasion: Safety, Prognosis, and Predictive Factors. Cardiovasc Intervent Radiol 38, 937–945 (2015). https://doi.org/10.1007/s00270-014-1032-9

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  • DOI: https://doi.org/10.1007/s00270-014-1032-9

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