Hepatocellular carcinoma with right atrial tumor thrombus

Abstract

Background Hepatocellular carcinoma with right atrial tumor thrombus is uncommon but with a dismal prognosis.

Methods By comprehensive retrieval of literature published between 2000 and 2019, 53 reports were obtained with 187 patients recruited into this study. The extracted data included patient characteristics, tumor characteristics, treatment, follow-up and outcomes. Statistical analyses applied were student t, Fisher exact and I² tests. Patients were devided into 6 groups according to treatment of choices: transarterial chemoembolization (TACE), surgery, radiotherapy, chemotherapy, interventional treatment and supportive care.

Results The overall survival rate of this cohort was 40.8 %. The survival rate of patients receiving TACE was 33.3 % and that of surgical patients was 41.9 %. The survival time of patients with TACE was longer than surgical patients, but lack of a statistical significance. Patients had a follow-up of 15.7 ± 16.6 (median 10) months. The patients receiving radiotherapy had the longest follow-up among all groups. Intra- and/or extrahepatic recurrence of hepatocellular carcinoma was the major morbidity. The mortality rates in a decremental sequence for patients receiving different treatments were supportive care > radiotherapy > surgery > TACE > interventional treatment. No difference was found in mortality between patients reported from case reports and those from non-case reports.

Conclusions Advanced hepatocellular carcinoma with right atrial thrombus is an aggressive malignancy. Based on the results of median survival time, radiotherapy and TACE seemed to be associated with an improved prognosis and possible better survival.

Zusammenfassung

Hintergrund Das hepatozelluläre Karzinom mit rechtsatrialem Tumorthrombus ist selten, die Prognose ist jedoch sehr ungünstig.

Methoden In einer umfassenden Recherche der zwischen 2000 und 2019 veröffentlichten Literatur konnten 53 Berichte mit 187 Patienten gewonnen werden, die in diese Studie aufgenommen wurden. Die extrahierten Daten umfassten Patientencharakteristika, Tumoreigenschaften, Behandlung, Nachbeobachtung und Ergebnisse. Für die statistische Analysen wurden die Student-T-Verteilung, der Exakte Test nach Fisher und der I² Test angewandt. Die Patienten wurden je nach Behandlungsart in 6 Gruppen eingeteilt: transarterielle Chemoembolisation (TACE), Operation, Strahlentherapie, Chemotherapie, interventionelle Behandlung und unterstützende Pflege.

Ergebnisse Die Gesamtüberlebensrate dieser Kohorte betrug 40,8 %. Die Überlebensrate der Patienten, die mit TACE behandelt wurden, lag bei 33,3 % und die der operierten Patienten bei 41,9 %. Die Überlebenszeit von Patienten mit TACE war länger als die der operierten Patienten, aber nicht statistisch signifikant länger. Das Follow-up der Patienten erstreckte sich über einen Zeitraum von 15,7 ± 16,6 (Median 10) Monate. Die Patienten mit Strahlentherapie erhielten von allen Gruppen das längste Follow-up. Hauptmorbidität waren intra- und/oder extrahepatische Rezidive des Leberzellkarzinoms. Die Mortalitätsraten in dekrementeller Abfolge für Patienten, die unterschiedliche Behandlungen erhielten, waren: supportive Versorgung > Strahlentherapie > Operation > TACE > interventionelle Behandlung. Bezüglich der Mortalität wurde kein Unterschied zwischen Patienten aus Fallberichten und Patienten, die nicht aus Fallberichten stammten, festgestellt.

Schlussfolgerungen Das hepatozelluläre Karzinom mit rechtsatrialem Tumorthrombus im fortgeschrittenen Stadium ist aggressiv maligne. Untersuchungen der medianen Überlebenszeit lassen darauf schließen, dass Strahlentherapie und TACE mit einer besseren Prognose und einer möglicherweise höheren Überlebenswahrscheinlichkeit assoziiert sein können.

Key words

hepatocellular carcinoma - right atrium - tumor thrombi - thalidomide

Schlüsselwörter

Hepatozelluläres Karzinom - rechter Vorhof - Tumorthromben - Thalidomid.

Publikationsverlauf

Eingereicht: 13. Mai 2020

Angenommen: 30. September 2020

Artikel online veröffentlicht:
05. November 2020

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