Download PDF
Z Gastroenterol 2021; 59(02): 153-161
DOI: 10.1055/a-1275-3780
Übersicht

Hepatocellular carcinoma with right atrial tumor thrombus

Hepatozelluläres Karzinom mit rechtsatrialem Tumorthrombus
Yi-Xian Guo 
  The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, China
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

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.


Publication History

Received: 13 May 2020

Accepted: 30 September 2020

Article published online:
05 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Chang JY, Ka WS, Chao TY. et al. Hepatocellular carcinoma with intra-atrial tumor thrombi. A report of three cases responsive to thalidomide treatment and literature review. Oncology 2004; 67: 320-326
    CrossrefPubMedGoogle Scholar
  • 2 Inoue Y, Hayashi M, Katsumata T. et al. Hepatocellular carcinoma with right atrial tumor thrombus: report of a case. Surg Today 2011; 41: 1122-1129
    CrossrefPubMedGoogle Scholar
  • 3 Wang Y, Yuan L, Ge RL. et al. Survival benefit of surgical treatment for hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: results of a retrospective cohort study. Ann Surg Oncol 2013; 20: 914-922
    CrossrefPubMedGoogle Scholar
  • 4 Uemura M, Sasaki Y, Yamada T. et al. Surgery for hepatocellular carcinoma with tumor thrombus extending into the right atrium: report of a successful resection without the use of cardiopulmonary bypass. Hepatogastroenterology 2004; 51: 1259-1262
    PubMedGoogle Scholar
  • 5 Abdelnabi M, Almaghraby A, Saleh Y. et al. Hepatocellular carcinoma with a direct right atrial extension in an HCV patient previously treated with direct-acting antiviral therapy: a case report. Egypt Heart J 2019; 71: 5
    CrossrefPubMedGoogle Scholar
  • 6 Alraies MC, Khan UA, Alraiyes AH. et al. Right atrium tumor thrombus. QJM 2013; 106: 679-680
    CrossrefPubMedGoogle Scholar
  • 7 Ariizumi SI, Kikuchi C, Tokitou F. et al. Cavo-atrial thrombectomy prior to hepatectomy for hepatocellular carcinoma with tumor thrombus in the right atrium: a case report. Surg Case Rep 2019; 5: 57
    CrossrefPubMedGoogle Scholar
  • 8 Bălăceanu LA, Diaconu CC, Aron G. Budd-Chiari syndrome as an initial presentation of hepatocellular carcinoma: a case report. Med Ultrason 2014; 16: 172-174
    CrossrefPubMedGoogle Scholar
  • 9 Chandra P, Shah S, Purandare N. et al. Hepatocellular carcinoma with intra-atrial tumor extension identified on 99mTc-labeled macroaggregated albumin single photon emission computed tomography/computed tomography. Indian J Nucl Med 2016; 31: 311-312
    CrossrefPubMedGoogle Scholar
  • 10 Chen M, Huang X, Yang Q. Hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus: a case report. Echocardiography 2019; 36: 2110-2113
    CrossrefPubMedGoogle Scholar
  • 11 Duan F, Yu W, Wang Y. et al. Trans-arterial chemoembolization and external beam radiation therapy for treatment of hepatocellular carcinoma with a tumor thrombus in the inferior vena cava and right atrium. Cancer Imaging 2015; 15: 7
    CrossrefPubMedGoogle Scholar
  • 12 Florman S, Weaver M, Primeaux P. et al. Aggressive resection of hepatocellular carcinoma with right atrial involvement. Am Surg 2009; 75: 1104-1108
    CrossrefPubMedGoogle Scholar
  • 13 Georgen M, Regimbeau JM, Kianmanesh R. et al. Removal of hepatocellular carcinoma extending in the right atrium without extracorporal bypass. J Am Coll Surg 2002; 195: 892-894
    CrossrefPubMedGoogle Scholar
  • 14 Ghimire S, Giri S, Morsy M. et al. A case of right atrial thrombus secondary to hepatocellular carcinoma. J Community Hosp Intern Med Perspect 2016; 6: 31443
    CrossrefPubMedGoogle Scholar
  • 15 Giuliani ME, Knox J, Dawson LA. Malignant intracardiac thrombus from hepatocellular carcinoma treated with external beam radiation therapy. J Palliat Med 2010; 13: 1293-1295
    CrossrefPubMedGoogle Scholar
  • 16 Hayashida K, Okumura S, Kawase T. Right atrial obstruction due to cardiac extension of hepatocellular carcinoma. Asian Cardiovasc Thorac Ann 2014; 22: 465-468
    CrossrefPubMedGoogle Scholar
  • 17 Kawakami M, Koda M, Mandai M. et al. Isolated metastases of hepatocellular carcinoma in the right atrium: case report and review of the literature. Oncol Lett 2013; 5: 1505-1508
    CrossrefPubMedGoogle Scholar
  • 18 Leo F, Rapisarda F, Stefano PL. et al. Cavo-atrial thrombectomy combined with left hemi-hepatectomy for vascular invasion from hepatocellular carcinoma on diseased liver under hypothermic cardio-circulatory arrest. Interact Cardiovasc Thorac Surg 2010; 10: 473-475
    CrossrefPubMedGoogle Scholar
  • 19 Leong K, Kuppasani K, Pyrsopoulos N. Atrial tumor thrombus: a rare complication of hepatocellular carcinoma. JAAPA 2019; 32: 23-26
    CrossrefPubMedGoogle Scholar
  • 20 Li AJ, Yuan H, Yin L. et al. Cavoatrial thrombectomy in hepatocellular carcinoma with tumor thrombus in the vena cava and atrium without the use of cardiopulmonary bypass. Ann Vasc Surg 2014; 28: 1565.e5-1568.e8
    CrossrefPubMedGoogle Scholar
  • 21 Li SS, Jian LL, Gang PB. et al. Removal of hepatocellular carcinoma extending into the right atrium with extracorporeal circulation. Hepatogastroenterology 2012; 59: 1591-1593
    PubMedGoogle Scholar
  • 22 Li W, Wang Y, Gao W. et al. HCC with tumor thrombus entering the right atrium and inferior vena cava treated by percutaneous ablation. BMC Surg 2017; 17: 21
    CrossrefPubMedGoogle Scholar
  • 23 Lou J, Li Y, Liang K. et al. Hypofractionated radiotherapy as a salvage treatment for recurrent hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: a multi-center analysis. BMC Cancer 2019; 19: 668
    CrossrefPubMedGoogle Scholar
  • 24 Lourenço LC, Horta DV, Alberto SF. et al. Hepatocellular carcinoma presenting with Budd-Chiari syndrome, right atrial thrombus and pulmonary emboli. Rev Esp Enferm Dig 2017; 109: 296-297
    PubMedGoogle Scholar
  • 25 Lubezky N, Nachmany I, Goykhman Y. et al. Surgical treatment of hepatocellular carcinoma with a tumor thrombus extending into the right atrium. Isr Med Assoc J 2018; 20: 590-591
    PubMedGoogle Scholar
  • 26 Luo X, Zhang B, Dong S. et al. Hepatocellular carcinoma with tumor thrombus occupying the right atrium and portal vein: a case report and literature review. Medicine (Baltimore) 2015; 94: e1049
    CrossrefPubMedGoogle Scholar
  • 27 Mancusi V, Ponsiglione A, Gambardella M. et al. Unique association of cardiac amyloidosis and right atrial tumor thrombus in a patient with hepatocellular carcinoma. Radiol Case Rep 2019; 14: 1140-1143
    CrossrefPubMedGoogle Scholar
  • 28 Mikhno L, Afzal A, Sonawala T. et al. Hepatocellular carcinoma presenting as an incidental right atrial mass. J Card Surg 2016; 31: 60
    CrossrefPubMedGoogle Scholar
  • 29 Miyazawa M, Torii T, Asano H. et al. Does a surgery for hepatocellular carcinoma with tumor thrombus highly occupying in the right atrium have significance? A case report and review of the literature. Hepatogastroenterology 2005; 52: 212-216
    PubMedGoogle Scholar
  • 30 Ohta M, Nakanishi C, Kawagishi N. et al. Surgical resection of recurrent extrahepatic hepatocellular carcinoma with tumor thrombus extending into the right atrium under cardiopulmonary bypass: a case report and review of the literature. Surg Case Rep 2016; 2: 110
    CrossrefPubMedGoogle Scholar
  • 31 Ohwada S, Takahashi T, Tsutsumi H. et al. Hepatocellular carcinoma with a tumour thrombus extending to the tricuspid valve: report of a successful en bloc resection. Hepatogastroenterology 2008; 55: 903-906
    PubMedGoogle Scholar
  • 32 Panduranga P, Al-Mukhaini M, Ratnam L. et al. Mobile right atrial thrombus with pulmonary thromboembolism in a patient with advanced hepatocellular carcinoma and disseminated tumor thrombosis. Heart Views 2011; 12: 173-177
    CrossrefPubMedGoogle Scholar
  • 33 Pandya H, Shah C, Lakhani J. et al. Intra-atrial tumour thrombus secondary to hepatocellular carcinoma. Australas Med J 2013; 6: 321-324
    CrossrefPubMedGoogle Scholar
  • 34 Pellicelli AM, Barbaro G, Soccorsi F. Contrast echocardiography of right atrial mass due to hepatocellular carcinoma. Acta Cardiol 2006; 61: 471-473
    CrossrefPubMedGoogle Scholar
  • 35 Pesi B, Giudici F, Moraldi L. et al. Hepatocellular carcinoma on cirrhosis complicated with tumoral thrombi extended to the right atrium: results in three cases treated with major hepatectomy and thrombectomy under hypothermic cardiocirculatory arrest and literature review. World J Surg Oncol 2016; 14: 83
    CrossrefPubMedGoogle Scholar
  • 36 Rallidis LS, Papadopoulos CC, Kelekis NL. et al. The role of myocardial contrast echocardiography to assess the origin of a mass in right cardiac cavities. Echocardiography 2009; 26: 88-92
    CrossrefPubMedGoogle Scholar
  • 37 Rose D, Chirichilli I, D’Ascoli R. et al. Giant right atrial thrombus in hepatocellular carcinoma: real-time characterization by cardiac magnetic resonance and real time three-dimensional echocardiography. Eur Rev Med Pharmacol Sci 2012; 16 (Suppl. 04) 81-83
    PubMedGoogle Scholar
  • 38 Sabzi F, Heidari A, Faraji R. Isolated right atrial mass in a candidate of coronary bypass grafting. Acta Med Iran 2017; 55: 722-725
    PubMedGoogle Scholar
  • 39 Saynak M, Ozen A, Kocak Z. et al. Sudden death: a case report of hepatocellular carcinoma with tumor thrombus extending into the right atrium. J BUON 2007; 12: 556
    PubMedGoogle Scholar
  • 40 Sempokuya T, Bolger Jr DT. Right atrium invasion of tumor thrombus from hepatocellular carcinoma incidentally found on transthoracic echocardiogram. Hawaii J Med Public Health 2018; 77: 131-134
    PubMedGoogle Scholar
  • 41 Sengodan P, Grewal H, Gandhi S. Invasive hepatocellular carcinoma with recurrent pulmonary embolism: use of AngioVac cannula thrombectomy device for mechanical aspiration. J Invasive Cardiol 2014; 26: E100-E103
    PubMedGoogle Scholar
  • 42 Shivathirthan N, Shimoda M, Kosuge T. et al. Recurrent hepatocellular carcinoma with tumor thrombus in right atrium – report of a successful liver resection with tumor thrombectomy using total hepatic vascular exclusion without concomitant cardiopulmonary bypass. Hepatogastroenterology 2012; 59: 872-874
    PubMedGoogle Scholar
  • 43 Shudo Y, Matsumiya G, Sakaguchi T. et al. Resection of advanced stage malignant retroperitoneal neoplasms with tumor thrombus extending into the right atrium: report of four cases. Surg Today 2011; 41: 262-265
    CrossrefPubMedGoogle Scholar
  • 44 Siddiqui MU, Khan M, Anderson T. Right atrial mass in a patient with HIV and hepatitis B: a case report. Cardiol Res 2013; 4: 165-167
    PubMedGoogle Scholar
  • 45 Subramanian R, Singh SA, Gupta S. et al. Perioperative anesthetic management of a combined right atrial thrombectomy with living donor liver transplantation. J Anaesthesiol Clin Pharmacol 2019; 35: 396-399
    CrossrefPubMedGoogle Scholar
  • 46 Sun JH, Zhang YL, Nie CH. et al. Long-term survival after chemoembolization of metastatic right atrial tumor thrombus as a presenting feature of hepatocellular carcinoma: a case study. Oncol Lett 2012; 3: 975-977
    CrossrefPubMedGoogle Scholar
  • 47 Sundriyal D, Bhargava S, Sharma N. et al. Cannon ball metastases and atrial thrombus. Indian J Surg Oncol 2015; 6: 311-312
    CrossrefPubMedGoogle Scholar
  • 48 Sung AD, Cheng S, Moslehi J. et al. Hepatocellular carcinoma with intracavitary cardiac involvement: a case report and review of the literature. Am J Cardiol 2008; 102: 643-645
    CrossrefPubMedGoogle Scholar
  • 49 Vicente E, Quijano Y, Ielpo B. et al. Cavoatrial thrombectomy without the use of cardiopulmonary bypass for abdominal tumors. Our experience and state of the art. Ann Vasc Surg 2015; 29: 1020.e1–e5
    CrossrefPubMedGoogle Scholar
  • 50 Wakayama K, Kamiyama T, Yokoo H. et al. Surgical management of hepatocellular carcinoma with tumor thrombi in the inferior vena cava or right atrium. World J Surg Oncol 2013; 11: 259
    CrossrefPubMedGoogle Scholar
  • 51 Wu CC, Hseih S, Ho WM. et al. Surgical treatment for recurrent hepatocellular carcinoma with tumor thrombi in right atrium: using cardiopulmonary bypass and deep hypothermic circulatory arrest. J Surg Oncol 2000; 74: 227-231
    CrossrefPubMedGoogle Scholar
  • 52 Yogita S, Tashiro S, Harada M. et al. Hepatocellular carcinoma with extension into the right atrium: report of a successful liver resection by hepatic vascular exclusion using cardiopulmonary bypass. J Med Invest 2000; 47: 155-160
    PubMedGoogle Scholar
  • 53 Zhu L, Yang R, Zhu X. Transcatheter arterial chemoembolization experience for advanced hepatocellular carcinoma with right atrial tumor thrombus. J Cancer Res Ther 2019; 15: 305-311
    PubMedGoogle Scholar
  • 54 Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-1022
    Google Scholar
  • 55 Chern MC, Chuang VP, Cheng T. et al. Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with inferior vena cava and right atrial tumors. Cardiovasc Intervent Radiol 2008; 31: 735-744
    CrossrefPubMedGoogle Scholar
  • 56 Izaki K, Sugimoto K, Sugimura K. et al. Transcatheter arterial embolization for advanced tumor thrombus with marked arterioportal or arteriovenous shunt complicating hepatocellular carcinoma. Radiat Med 2004; 22: 155-162
    PubMedGoogle Scholar
  • 57 Le Treut YP, Grégoire E, Fara R. et al. The technique and outcomes of central hepatectomy by the Glissonian suprahilar approach. Eur J Surg Oncol 2019; 45: 2369-2374
    CrossrefPubMedGoogle Scholar
  • 58 Chen J, Huang J, Chen M. et al. Transcatheter arterial chemoembolization (TACE) versus hepatectomy in hepatocellular carcinoma with macrovascular invasion: a meta-analysis of 1683 patients. J Cancer 2017; 8: 2984-2991
    CrossrefPubMedGoogle Scholar
  • 59 Ribeiro de Souza A, Reig M, Bruix J. Systemic treatment for advanced hepatocellular carcinoma: the search of new agents to join sorafenib in the effective therapeutic armamentarium. Expert Opin Pharmacother 2016; 17: 1923-1936
    CrossrefPubMedGoogle Scholar
  • 60 Sangiovanni A, Colombo M. Treatment of hepatocellular carcinoma: beyond international guidelines. Liver Int 2016; 36 (Suppl. 01) 124-129
    CrossrefPubMedGoogle Scholar