Extrahepatic Collateral Artery Supply to the Tumor Thrombi of Hepatocellular Carcinoma Invading Inferior Vena Cava: The Prevalence and Determinant Factors
Received 18 January 2008; received in revised form 8 September 2008; accepted 29 September 2008. published online 21 November 2008.
Purpose
To retrospectively evaluate the prevalence of extrahepatic collateral artery supply to tumor thrombi of hepatocellular carcinomas (HCCs) invading the inferior vena cava (IVC) and to assess the determining factors.
Materials and Methods
From February 1998 to June 2007, 82 patients with IVC tumor thrombi on computed tomography (CT) underwent angiographic evaluation of their extrahepatic collateral artery supply. Potential determining factors for extrahepatic collateral artery supply to the IVC tumor thrombi included sex, age, Child-Pugh class, history of chemoembolization, tumor factors (ie, size, number, and growth pattern), distance from primary tumor to IVC thrombi, portal vein invasion, and extent of IVC thrombi (ie, occupying more than half the IVC lumen on transverse CT image, completely filling and distending IVC lumen, or extending into the right atrium). Univariate analysis and multiple logistic regression analysis were performed.
Results
Fifty-four of the 82 patients (65.9%) had extrahepatic collateral artery supply: 47 from the right inferior phrenic artery, four from the right adrenal artery, two from the right internal mammary artery, and one from the right renal artery. The presence of extrahepatic collateral artery supply to IVC tumor thrombi showed a significant relationship with a history of chemoembolization (P = .001, odds ratio [OR] = 22.4) and distension of IVC by tumor thrombi (P = .005, OR = 9.1).
Conclusions
IVC tumor thrombi of HCCs are frequently supplied by extrahepatic collateral arteries, the most common of which is the right inferior phrenic artery. The significant determining factors are a history of chemoembolization and the extent of IVC tumor thrombi.
aDepartment of Radiology, Seoul National University College of Medicine, Seoul, Korea
bInstitute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
cClinical Research Institute , Seoul National University Hospital, Seoul, Korea
dDepartment of Surgery and Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonbuk Cancer Center, Chonbuk National University Hospital, Jeonju, Korea
Address correspondence to J.W.C., Department of Radiology, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
This study was supported by grant 0620220-1 from the National R & D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea. None of the authors have identified a conflict of interest.
ABSTRACT