Clin Mol Hepatol.  2017 Jun;23(2):160-169. 10.3350/cmh.2016.0088.

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

Affiliations
  • 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kimkm70@amc.seoul.kr
  • 2Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Little is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion.
METHODS
A total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included.
RESULTS
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, Ps <0.001, respectively).
CONCLUSIONS
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.

Keyword

Hepatocellular carcinoma; Bile duct invasion; Treatment; Prognosis; Obstructive jaundice

MeSH Terms

Aged
Bile Duct Neoplasms/*diagnosis/secondary
Bile Ducts/pathology
Carcinoma, Hepatocellular/*diagnosis/mortality/pathology/therapy
Chemoembolization, Therapeutic
Female
Humans
Jaundice/etiology
Liver Neoplasms/*diagnosis/mortality/pathology/therapy
Male
Middle Aged
Neoplasm Staging
Prognosis
Proportional Hazards Models
Retrospective Studies
Survival Rate
Treatment Outcome
alpha-Fetoproteins/analysis
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