Abstract Body: Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide and has an aggressive metastatic potential. Cardiac metastasis from HCC is a rare but clinically significant event that complicates diagnosis and management, impacting patient prognosis severely.
Objective: This systematic review and meta-analysis aim to assess the incidence, pathophysiology, diagnostic modalities, treatment strategies, and survival outcomes of cardiac metastasis in HCC patients, emphasizing the importance of early detection and multidisciplinary intervention.
Methods: A comprehensive and systematic review of the literature was performed in accordance with PRISMA guidelines. PubMed, Scopus, and Embase were queried to identify all relevant case reports and case series published from 1980 to 2023. Studies were selected based on predefined eligibility criteria, and data on patient demographics, clinical features, diagnostic methods, treatment outcomes, and survival rates were extracted and analyzed.. Statistical analyses were performed using R, applying meta-analysis techniques to calculate pooled prevalence and case fatality rates (CFR).
Results
A total of 127 studies were included, comprising 276 patients with HCC and cardiac metastasis. The right atrium was the most frequently affected site (67.75%), followed by the right ventricle (12.32%). Cardiac metastases were primarily associated with vascular invasion, with the inferior vena cava (IVC) being involved in over 90% of cases. The pooled case fatality rate (CFR) was estimated at 0.72 (95% CI: 0.53–0.88) using the random effects model, indicating a high mortality risk. The presence of heart failure significantly correlated with increased mortality, and despite various treatment approaches—including surgery, transarterial chemoembolization (TACE), systemic therapy, and radiotherapy—long-term survival remained poor, with only 15.58% of patients surviving beyond one year.
Conclusion: Cardiac metastasis in HCC, though uncommon, represents a critical prognostic factor with high mortality. Early recognition and a multidisciplinary treatment strategy integrating oncology, cardiology, and interventional radiology are essential to optimize patient outcomes. Further research into innovative diagnostic tools and targeted therapies is warranted to improve survival rates in this challenging patient population.