Prognoses and Clinicopathological Characteristics for Hepatocellular Carcinoma Originating from the Caudate Lobe After Surgery

Abstract

1Background: The aims were to evaluate the prognoses, and clinicopathological characteristics of 2 solitary hepatocellular carcinoma (HCC) originating from the caudate lobe (HCC-CL). 3 Methods:We analyzed 584 patients with a solitary tumor < 10 cm from January 1990 to November 4 2014. Patients were classified into a caudate lobe group (CL; n = 39) and a non-caudate lobe group 5 (NCL; n = 545). We investigated the prognoses and clinicopathological characteristics of solitary 6 HCC-CL. We compared the surgical procedures performed in these cases. 7Results: HCC-CL had a similar rate of portal venous invasion (PVI) as HCC-NCL (21% vs. 19%); 8 however, the frequency of tumor thrombus at the first branch of the portal vein (PV) or extension to 9 the trunk or the opposite side of the PV was significantly higher in HCC-CL (8% vs. 2%). HCC-CL 10 had similar OS rates compared to HCC-NCL; however, HCC-CL showed significantly poorer RFS. 11Although there were not significant differences among the three surgical procedure, blood loss and 12 complication rates tended to be higher in cases underwent an isolated caudate lobectomy. Tumor size 13 ≥5 cm, PVI, and liver fibrosis or cirrhosis (LF or LC) were independent unfavorable factors for both 14 OS and RFS. PIVKA-II ≥120 mAU/ml was an independent unfavorable factor for RFS. 15Conclusion: HCC-CL presented a poorer RFS rate. Patients with a tumor size ≥5 cm, PIVKA-II ≥120 16 mAU/ml, portal venous invasion, and LF or LC should be diligently followed-up as these cases have 17 a high risk of recurrence. 18 19 20

Caudate Lobe Hepatocellular Carcinoma Treated with Sequential Transarterial Chemoembolization and Iodine 125 Seeds Implantation: A Single-Center Retrospective Study

“…Several studies have reported various clinical results of surgical resection, including 3- and 5-year OS of 47–83% and 21–76%, respectively. 5 , 36 , 39 The reported OS rates with RFA or chemoembolization for HCC-CL varied as follows: 59–86.6% at 3 years, and 44–67.5% at 5 years, 19 , 40–43 which were similar to those after surgical resection. However, the tumor size > 2 cm and intrahepatic tumor number are associated with poor prognosis after ablation.…”

“…2,3 Cases of HCC originating in the caudate lobe (HCC-CL) are rare, with an incidence rate between 1.9% and 12.4%. [4][5][6][7] The implementation of surveillance programs for high-risk populations and advances in diagnostic imaging technology has increased the diagnosis rate of HCC-CL. 8,9 The surgical resection and percutaneous radiofrequency ablation (RFA) can be used as a curative treatment for HCC-CL.…”

“…10 However, the resection of the HCC-CL is challenging for accomplished surgeons owing to the tumor's deep location that is adjacent to the inferior vena cava and hepatic vein and has a narrow surgical margin. 4,5,11,12 Thus, radiofrequency therapy cannot be administered safely under certain circumstances, such as thermal injury of adjacent structure, heat sink effect (near major vessels), and limited tumor necrosis range. [13][14][15] Currently, transarterial chemoembolization (TACE) therapy that effectuates tumor necrosis through the occlusion of blood flow and the slow release of chemotherapeutic drugs into tumors is the primary palliative treatment option for unresectable HCC.…”

“… 10 However, the resection of the HCC-CL is challenging for accomplished surgeons owing to the tumor’s deep location that is adjacent to the inferior vena cava and hepatic vein and has a narrow surgical margin. 4 , 5 , 11 , 12 Thus, radiofrequency therapy cannot be administered safely under certain circumstances, such as thermal injury of adjacent structure, heat sink effect (near major vessels), and limited tumor necrosis range. 13–15 …”

Superselective Transarterial Chemoembolization for Unresectable or “Ablation Unsuitable” Hepatocellular Carcinoma in the Caudate Lobe: A Real World, Single-Center Retrospective Study

“…Hepatocellular carcinoma (HCC) is a common malignancy, with incidence and mortality rates ranking sixth and third in the world, respectively (1). Cases of HCC arising or involving the caudate lobe (HCC-CL) are relatively rare, and its incidence is reported to be between 1.9% and 12.4% (2)(3)(4)(5)(6)(7). Although the implementation of surveillance programs for high-risk populations and advances in imaging diagnostic technology have increased the diagnosis rate of HCC-CL (8,9), about 80% of patients have tumors that are unresectable owing to either severe hepatitis-related cirrhosis or tumor invasion of the intrahepatic vessels (10).…”