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. 2017 Jun;23(2):160-169.
doi: 10.3350/cmh.2016.0088. Epub 2017 May 16.

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

Jihyun An  1   2 , Kwang Sun Lee  1   2 , Kang Mo Kim  1   2 , Do Hyun Park  2 , Sang Soo Lee  2 , Danbi Lee  1   2 , Ju Hyun Shim  1   2 , Young-Suk Lim  1   2 , Han Chu Lee  1   2 , Young-Hwa Chung  1   2 , Yung Sang Lee  1   2
Affiliations

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

Jihyun An et al. Clin Mol Hepatol. 2017 Jun.

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.

Keywords: Bile duct invasion; Hepatocellular carcinoma; Obstructive jaundice; Prognosis; Treatment.

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Conflict of interest statement

Conflicts of Interest:The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Patient flow diagram. HCC, hepatocellular carcinoma; CT, computed tomography.
Figure 2.
Figure 2.
Overall survival of patients with hepatocellular carcinoma complicated with bile duct invasion at the time of diagnosis. (A) Overall survival (n=247). (B) Overall survival according to Barcelona Clinic Liver Cancer (BCLC) stage (n=247). (C) Overall survival according to the level of bile duct invasion (n=247). (D) Overall survival of 88 patients with obstructive jaundice, as a function of biliary drainage.
Figure 3.
Figure 3.
Overall survival of 165 patients with HCC BCLC stage C and bile duct invasion as a function of treatment modality. HCC, hepatocellular carcinoma; BCLC, Barcelona Clinic Liver Cancer; TACE, transarterial chemoembolization- containing regimen; CM, conservative management.
See this image and copyright information in PMC

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