Hepatocellular Carcinoma with Internal Mammary Artery Supply: Feasibility and Efficacy of Transarterial Chemoembolization and Factors Affecting Patient Prognosis

Purpose: To determine technical feasibility, therapeutic efficacies, and identify prognostic factors in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization via the internal mammary artery.

Materials And Methods: From August 1996 to July 2005, the authors identified the internal mammary arteries supplying HCCs in 97 (2.2%) of 4,438 HCC patients. Computed tomography scans and digital subtraction angiography images of these 97 patients were retrospectively reviewed by consensus between two of the authors regarding technical success and clinical outcome. The technical success of internal mammary artery chemoembolization was defined as achievement of catheterization into feeding vessels, delivery of drugs via those vessels, and no residual tumor staining fed by the internal mammary artery. Multivariate Cox proportional hazard regression analysis was performed to enable evaluation of prognostic factors for survival.

Results: Technical success by selective chemoembolization via internal mammary artery was achieved in 53 (55%) of the 97 patients. The clinical responses of the 97 patients were complete remission (n=3), partial remission (n=19), no response (n=65), and no available follow-up image (n=10). Overall cumulative survival rates, calculated from times of internal mammary artery chemoembolization, were 55.9% (at 6 months), 32.5% (at 1 year), 15.4% (at 2 years), and 8.2% (at 3 years). Multivariate analysis showed that tumor multiplicity (single vs multiple nodular or diffuse; P=.013), portal vein thrombosis (P=.004), and the technical success of internal mammary artery chemoembolization (P=.02) each significantly affected survival.

Conclusions: Although patients with HCC supplied by the internal mammary artery had poor prognosis because of their advanced stage of disease, chemoembolization via the internal mammary artery is possible and worth performing in selective situations.