Kim Seung Up, Kim Yu Ri, Kim Do Young, Kim Ja Kyung, Lee Hyun Woong, Kim Beom Kyung, Han Kwang Hyub, Chon Chae Yoon, Moon Young Myoung, Ahn Sang Hoon
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean J Hepatol. 2007 Sep;13(3):387-95. doi: 10.3350/kjhep.2007.13.3.387.
BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with an extension to the inferior vena cava (IVC) or right atrium is uncommon, and its prognosis remains unclear due to the few case reports. In order to elucidate the natural history and treatment outcome, this study investigated advanced HCC patients with an IVC invasion or atrial tumor thrombus.
Between November 1987 and June 2004, a total of 41 patients were diagnosed as having HCC with IVC or right atrial involvement using the new imaging techniques including a two-dimensional echocardiography. Those patients were stratified into the untreated 'control group' (n=17) and 'treated group' (n=24). The clinical features, treatment outcome and prognosis including patient survival were analyzed.
The mean age of the total patients was 55 years (male:female, 33:8). The most common cause of HCC was a hepatitis B virus infection (85.4%), followed by a hepatitis C virus infection (7.4%). According to the Child-Pugh classification, 24 patients were Child-Pugh class A (58.5%), 15 were Child-Pugh class B (36.6%), and 2 were Child-Pugh class C (4.9%). Lung metastases were identified in 10 patients (24.5%). The treatment modalities of the treated group included 11 systemic chemotherapy regimens (5-FU and cisplatin), 10 transarterial chemotherapy regimens, 2 chemoradiation procedures and 1 hepatic resection. The overall survival was 3.0 months (range, 1-29 months). The 6 month survival rate was 23.5% (4/17) in the control group and 29.2% (7/24) in the treated group. The 12 months survival rate was 0% (0/17) and 25.0% (6/24), respectively. Independent prognostic factor affecting the survival was whether or not any treatment had been carried out.
Although the prognosis of advanced HCC with IVC invasion or a right atrial tumor thrombi is poor, treatment might improve the survival rate.
背景/目的：肝细胞癌（HCC）侵犯下腔静脉（IVC）或右心房的情况并不常见，由于病例报告较少，其预后仍不明确。为了阐明其自然病史和治疗结果，本研究调查了伴有IVC侵犯或心房肿瘤血栓的晚期HCC患者。
在1987年11月至2004年6月期间，共有41例患者通过包括二维超声心动图在内的新成像技术被诊断为患有伴有IVC或右心房受累的HCC。这些患者被分为未治疗的“对照组”（n = 17）和“治疗组”（n = 24）。分析了临床特征、治疗结果和预后，包括患者生存率。
所有患者的平均年龄为55岁（男：女，33：8）。HCC最常见的病因是乙型肝炎病毒感染（85.4%），其次是丙型肝炎病毒感染（7.4%）。根据Child-Pugh分类，24例患者为Child-Pugh A级（58.5%），15例为Child-Pugh B级（36.6%），2例为Child-Pugh C级（4.9%）。10例患者（24.5%）发现有肺转移。治疗组的治疗方式包括11种全身化疗方案（5-氟尿嘧啶和顺铂）、10种经动脉化疗方案、2种放化疗程序和1例肝切除术。总生存期为3.0个月（范围，1 - 29个月）。对照组6个月生存率为23.5%（4/17），治疗组为29.2%（7/24）。12个月生存率分别为0%（0/17）和25.0%（6/24）。影响生存的独立预后因素是是否进行了任何治疗。
尽管伴有IVC侵犯或右心房肿瘤血栓的晚期HCC预后较差，但治疗可能会提高生存率。
