Hepatocellular Carcinoma Associated with Membranous Obstruction of the Inferior Vena Cava: Incidence, Characteristics, and Risk Factors and Clinical Efficacy of TACE

Purpose: To analyze the characteristics associated with membranous obstruction of the inferior vena cava (MOVC) associated hepatocellular carcinoma (HCC) and to evaluate the clinical efficacy of transcatheter arterial chemoembolization ( 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 tomography, 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 development 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 cumulative 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 nodular 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 similar to that found in other studies. TACE resulted in an effective tumor response for HCC and seemed to be effective 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. (C) RSNA, 2010