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

Abstract

Background/AimsLittle is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion.MethodsA total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included.ResultsThe 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).ConclusionsThe 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.

Transarterial Chemolipiodolization for Hepatocellular Carcinoma with Central Bile Duct Invasion Causing Conjugated Hyperbilirubinemia: Safety and Prognostic Factors for Survival

“…In previous studies about the icteric type of HCC, patients with bile duct invasion were most likely to have a poor prog- nosis because of the strong association with vascular invasion and PVTT. 7 In those studies, PVTT was present in up to 88% of cases with bile duct invasion. In our results, PVTT was found in 62% of patients with hyperbilirubinemia and 54% of patients without hyperbilirubinemia; however, PVTT was not a significant factor affecting overall survival in the univariate analysis (Table 3).…”

“…According to the results of previous studies reported to date, HCC patients with bile duct invasion showed a worse prognosis than patients without bile duct invasion. 7,20 Thus far, TACL is the only treatment modality for controlling intrahepatic tumor lesions in patients with bile duct invasion; however, the efficacy and safety of the treatment are still controversial. 11 Radiofrequency ablation can cause life-threatening complications such as structural injuries in bile ducts or intrahepatic vessels, and transarterial radioembolization or radiation therapy as an alternative to TACL are not commonly used methods for these patients.…”

“…4 According to previous reports, patients with bile duct invasion have a poor prognosis because of the high rates of vascular invasion or portal vein tumor thrombus (PVTT). 6,7 However, some researchers have suggested that early detection due to obstructive jaundice can lead to opportunities for treatment. 4 A standard treatment for HCC patients with bile duct invasion has not been established due to limited data, and the prognosis of such patients has not been studied in detail previously.…”

Triple Covered Metal Stent Deployment Using Side-by-Side Technique for Hemobilia due to Hepatocellular Carcinoma (with Video)

“…As conservative treatment, transarterial chemoembolization or radiofrequency treatment was considered. However, liver function is not always favorable for these conservative treatments, therefore, endoscopic biliary drainage should be considered as the first step in non-surgical treatment for such cases [8].…”

Left hepatectomy with concomitant cavo-atrial and biliary tumor thrombectomy for invasive hepatocellular carcinoma: a video report

“…Representing the prevalent primary hepatic malignancy, hepatocellular carcinoma (HCC) is concurrently the sixth most common cancer worldwide and the third dominant cause of mortality due to cancer (1,2).…”