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.

Unusual sites of hepatocellular carcinoma metastasis: Case report

“…HCC can rarely extend into IVC and the right atrium, with an incidence of 0.67%-4.1%. [11][12][13] Some case reports have documented optimal management of HCC with extensive tumor thrombus burden by radical hepatic resection and removal of the intracardiac mass, however, many patients with HCC are poor surgical candidates due to overall functional decline. 14,15 Given the rarity of primary cardiac tumors, the extrahepatic origin of cardiac masses should be considered, especially in patients with advanced liver disease.…”

Case Report: Radiotherapy Plus Immunotherapy and Lenvatinib for the Treatment of Recurrent Hepatocellular Carcinoma With a Right Atrium and Inferior Vena Cava Tumor Thrombus

“…The OS was 40.8% in these patients, indicating effective radiotherapy. The major morbidity was due to intra or extrahepatic recurrence of HCC ( 25 ). Fleckenstein et al.…”