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. 2021 Apr 28:13:3551-3560.
doi: 10.2147/CMAR.S307065. eCollection 2021.

Efficacy and Safety of Transarterial Chemoembolization for the Treatment of Unresectable Hepatocellular Carcinoma Associated with Bile Duct Tumor Thrombus: A Real-World Retrospective Cohort Study

Jin-Kai Feng #  1 , Ju-Xian Sun #  1 , Zong-Han Liu #  1 , Jing-Wen Gu #  2 , Zhen-Hua Chen  3 , Chang Liu  1 , Wei-Xing Guo  1 , Jie Shi  1 , Shu-Qun Cheng  1
Affiliations

Efficacy and Safety of Transarterial Chemoembolization for the Treatment of Unresectable Hepatocellular Carcinoma Associated with Bile Duct Tumor Thrombus: A Real-World Retrospective Cohort Study

Jin-Kai Feng et al. Cancer Manag Res. .

Abstract

Background: The occurrence of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The aim of the study was to evaluate the effectiveness and safety of transarterial chemoembolization (TACE) for patients with unresectable HCC with BDTT.

Methods: This retrospective study was conducted on newly diagnosed HCC and BDTT patients who were initially treated with TACE or conservative management (CM) from 2009 to 2018. Survival outcomes of patients treated with TACE were compared with those of patients given CM. Multivariate analyses were performed to identify independent prognostic factors related to survival.

Results: Out of 100 patients included in this study, 40 patients underwent TACE, while the remaining 60 received CM. The median survival time of the TACE group was 8.0 months longer than that of the CM group (13.0 versus 5.0 months, P < 0.001). The 6-, 12-, 18-, 24-month overall survival (OS) rates were 90.0%, 52.5%, 22.5%, and 12.5%, respectively, for the TACE group compared with 26.7%, 8.3%, 5.0%, and 3.3%, respectively, for the CM group. Multivariate analyses showed that treatment allocation (hazard ratio [HR], 0.421; 95% confidence interval [CI], 0.243-0.730; P = 0.002), Child-Pugh status (HR, 2.529; 95% CI, 1.300-4.920; P = 0.006) and total bilirubin level (HR, 1.007; 95% CI, 1.004-1.009; P < 0.001) on first admission were independent predictors of OS. There was no procedure-related mortality within one month after TACE treatment.

Conclusion: TACE is a safe and effective treatment method that may improve the OS of patients with unresectable HCC with BDTT.

Keywords: bile duct tumor thrombus; conservative management; hepatocellular carcinoma; overall survival; transarterial chemoembolization.

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Conflict of interest statement

Jin-Kai Feng, Ju-Xian Sun, Zong-Han Liu, and Jing-Wen Gu are co-first authors for this study. The authors declare that they have no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
Flowchart of screening all HCC patients with BDTT who underwent either TACE or CM as initial treatment.
Figure 2
Figure 2
Kaplan–Meier curves of overall survival in HCC patients with BDTT who underwent TACE or CM (P < 0.001).
Figure 3
Figure 3
Subgroup analysis of overall survival in HCC patients with BDTT who underwent initial TACE or CM stratified using baseline liver function (Child–Pugh class A or B) and total bilirubin concentration (≤51 or >51 μmol/L). (A) survival curves for HCC patients with BDTT with Child–Pugh class A liver function (P < 0.001); (B) survival curves for HCC patients with BDTT with Child–Pugh class B liver function (P = 0.003); (C) survival curves for HCC patients with BDTT with total bilirubin level ≤51 μmol/L (P = 0.079); (D) survival curves for HCC patients with BDTT with total bilirubin level >51 μmol/L (P = 0.005).
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