Abstract
PurposeTo evaluate the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with different areas of right retroperitoneal space (rRPS) invasion and analyze the blood supply.MethodsThis retrospective study enrolled 41 patients with HCC with different areas of rRPS invasion treated with TACE, including 22 HCCs with superior aspect of the right perirenal space (SARPS) invasion and 19 HCCs with right anterior pararenal space (RAPS) invasion. The overall response rate (ORR) and disease control rate (DCR) were analyzed. The prognostic factors for overall survival (OS) after TACE were determined. The blood supply characteristics of HCC with different areas of rRPS invasion were analyzed with arteriograms.ResultsAll patients underwent 2.8 ± 1.8 TACE sessions over 25.0 ± 21.9 months. The median OS was 29.0 months for patients with SARPS invasion and 12.0 months for patients with RAPS invasion (P = 0.004). Only the invaded area of the rRPS was an independent prognostic factor for OS [hazard ratio (HR), 2.833; 95% CI, 1.297–6.188; and P = 0.009). The ORR and DCR were significantly higher in the group with SARPS invasion than in the group with RAPS invasion (ORR: 63.6% vs 31.6%, P = 0.041; DCR: 77.3% vs 47.4%, P = 0.047). Initially, HCC with SARPS invasion were supplied by the hepatic artery (HA; n = 8) and both the HA and extrahepatic collateral vessels (EHCs; n = 14); HCC with RAPS invasion were supplied by the HA (n = 10) and both the HA and EHCs (n = 9); as the TACE sessions increased, the tumor-feeding vessels shifted from the HA to both the HA and EHCs, and even EHCs could be the only blood supply. Rare EHCs appeared earlier and more frequently in the RAPS group than in the SARPS group.ConclusionThe efficacy of TACE differed for HCC with different areas of rRPS invasion, and the median OS, ORR and DCR were significantly better in the SARPS group than in the RAPS group. Different common EHCs supplied HCCs with different areas of rRPS invasion, while other rare EHCs appeared more frequently in the RAPS group.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third-most common cause of cancer mortality globally [1]
1 patient (2.4%) with Barcelona Clinic Liver Cancer (BCLC) stage A, 19 patients (46.3%) with BCLC stage B, and 21 patients (51.2%) with BCLC stage C HCC were enrolled in this study. 21 patients had portal vein (PV)/hepatic vein (HV) branch invasion, including 18 patients with PV branch invasion, 2 patients with right HV invasion, and 1 patient with PV branch and right HV invasion simultaneously, and all patients without main PV invasion. 22 patients (53.7%) had HCC with superior aspect of the right perirenal space (SARPS) invasion via the inferior surface of segment 7, and 19 patients (46.3%) had HCC with right anterior pararenal space (RAPS) invasion via the inferior surface of segment 6
The invaded area of the retroperitoneal space (rRPS), maximum tumor size, alphafetoprotein (AFP), presence of portal hypertension, and PV/HV branch invasion were significantly associated with overall survival (OS) in the univariate analysis (Table 2; P < 0.1)
Summary
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third-most common cause of cancer mortality globally [1]. Once HCC invades the right retroperitoneal space (rRPS), patients often lose the chance to undergo surgery, and other treatment methods, such as ablation and high-intensity focused ultrasound (HIFU), are not effective. The rates of post-treatment residual HCC remain high, and repeated TACE therapy is often needed [7, 8]. One important factor that impacts the effect of TACE is insufficient suppression of the formation of extrahepatic collateral vessels (EHCs) in HCC [9, 10]. These potential EHCs can seriously inhibit the effectiveness of TACE and lead to multiple recurrences
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