Clinical features and outcomes of patients with hepatocellular carcinoma complicated with bile duct invasion

• Published in: Clinical and molecular hepatology Vol. 23; no. 2; pp. 160 - 169
• Main Authors: An, Jihyun, Lee, Kwang Sun, Kim, Kang Mo, Park, Do Hyun, Lee, Sang Soo, Lee, Danbi, Shim, Ju Hyun, Lim, Young-Suk, Lee, Han Chu, Chung, Young-Hwa, Lee, Yung Sang
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of the Liver 01-06-2017; The Korean Association for the Study of the Liver; 대한간학회
• Subjects: Aged; alpha-Fetoproteins - analysis; Bile duct invasion; Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - secondary; Bile ducts; Bile Ducts - pathology; Blood clots; Cancer therapies; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; Cholangitis; Cohort analysis; Endoscopy; Female; Hepatitis B; Hepatitis C; Hepatocellular carcinoma; Humans; Jaundice - etiology; Liver cancer; Liver diseases; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Magnetic resonance imaging; Male; Medical prognosis; Metastasis; Middle Aged; Neoplasm Staging; Obstructive jaundice; Original; Patients; Prognosis; Proportional Hazards Models; Retrospective Studies; Survival analysis; Survival Rate; Thrombosis; Tomography; Treatment; Treatment Outcome; Variables; Variance analysis; Veins & arteries; 내과학; United States > US; Obstructive jaundice; Bile duct invasion; Hepatocellular carcinoma; Prognosis; Treatment
• ISSN: 2287-2728; 2287-285X
• DOI: 10.3350/cmh.2016.0088

Little is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion.
A total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included.
The majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39,
<0.001, respectively).
The survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.