Radiology: Volume 254: Number 2—February 2010
Dong II Gwon, MD Gi-Young Ko, MD Hyun-Ki Yoon, MD Kyu-Bo Sung, MD Jin Hyoung Kim, MD Seung Soo Lee, MD Jae Myeong Lee, MD Joon-Young Ohm, MD Ji Hoon Shin, MD Ho-Young Song, MD
Purpose: To analyze the characteristics associated with membra- nous obstruction of the inferior vena cava (MOVC)- associated hepatocellular carcinoma (HCC) and to evaluate the clinical efficacy of transcatheter arterial chemoembo- lization (TACE).
Materials and Methods: This retrospective study was approved by an institutional review board, and informed consent was waived. Ninety-eight patients (mean age, 48.5 years ± 12.9 [standard deviation]) with MOVC were retrospectively evaluated. The diagnosis of Budd-Chiari syndrome was confirmed with results from Doppler ultrasonography, computed to¬mography, magnetic resonance imaging, and/or inferior venacavography. The cumulative incidences of HCC and the patient survival period were calculated by using the Kaplan-Meier method. Factors associated with the devel¬opment of HCC were evaluated by using multivariate Cox regression analysis.
Results: Among 98 patients with MOVC, liver nodules were detected in 37 patients (38%), 23 of whom had HCC associated with MOVC and 14 of whom had benign nodules. The cu¬mulative incidence of HCC at 1, 5, and 10 years was 7.3%, 13.5%, and 31.8%, respectively. Female sex was the only significant factor associated with the development of HCC (odds ratio, 6.02; P <.001). HCC was of the single nodu¬lar type and of peripheral location. Among 23 patients with HCC, 20 patients were treated with only TACE and three with liver transplantation after TACE. After TACE, 14 (61%) of the study patients had a complete response, and survival rates at 1, 2, 3, 4, and 5 years were 90%, 85%, 61%, 61%, and 46%, respectively.
Conclusion: The incidence of HCC in patients with MOVC was simi¬lar to that found in other studies. TACE resulted in an effective tumor response for HCC and seemed to be ef¬fective in prolonging patient survival. Female sex was the only significant factor associated with the development of HCC. A single nodular tumor with a peripheral location appears to have a higher probability of HCC.