Prognostic importance of bile duct invasion in surgical resection with curative intent for hepatocellular carcinoma using PSM analysis

Yang, Xinwei; Qiu, Zhiquan; Ran, Rongzhen; Cui, Longjiu; Luo, Xiang; Wu, Mengchao; Tan, Weifeng; Jiang, Xiaoqing

doi:10.3892/ol.2018.9108

Cited by 15 publications

(25 citation statements)

References 30 publications

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“…The RFS rates in the BDTT group were significantly worse than those in the group without BDTT before PSM in the present study, which is consistent with the results of previous studies ( 8 , 21 ). However, Kim et al ( 22 ) reported that RFS rates between the two groups were not significantly different.…”

Section: Discussionsupporting

confidence: 93%

“…Another notable area for comparison is whether postoperative survival among HCC patients with BDTT is equal to that among HCC patients without BDTT. Yang et al ( 21 ) reported that the median OS time in the BDTT group (16.6 months) was significantly worse than that in the group without BDTT (84.0 months). Other studies ( 8 , 22 , 23 ) have also illustrated that, compared with the OS in the group without BDTT, the OS of the BDTT group was significantly poorer.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of resection for hepatocellular carcinoma with macroscopic bile duct tumour thrombus: A propensity score matched study

et al. 2020

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The incidence of hepatocellular carcinoma (HCC) with bile duct tumour thrombus (BDTT) is low, and related studies, especially studies on long-term survival, are uncommon. The present study aimed to evaluate the clinicopathological characteristics, prognostic factors and postoperative long-term outcomes of BDTT in patients with HCC. The clinicopathological characteristics and postoperative long-term outcomes of patients with HCC both with and without BDTT were compared before and after propensity score matching (PSM). Prognostic risk factors were assessed by Cox proportional hazards regression analyses after PSM. Tumour stages in the BDTT group were significantly higher than those in the group without BDTT (P=0.001). Overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in the group without BDTT than in the BDTT group before PSM (P<0.001 and P=0.003, respectively). However, no significant difference in OS or RFS was found between the two groups after PSM (P=0.249 and P=0.121, respectively). Moreover, the median OS and RFS times of the BDTT patients who underwent tumour thrombectomy and bile duct resection were not significantly different (P=0.891 and P=0.787, respectively). In the multivariate analysis, macrovascular invasion (HR, 3.701; 95% CI, 1.313-9.10.437; P=0.013) was the only independent predictor of OS. Although the clinicopathological characteristics of the BDTT group suggested more advanced stage disease and poorer oncological outcomes than the group without BDTT, BDTT was not a poor prognostic factor for patients with HCC who underwent liver resection. Curative resection is recommended for patients with HCC and BDTT, even for those with poor liver function, after proper perioperative management in order to achieve good long-term survival.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Outcomes of resection for hepatocellular carcinoma with macroscopic bile duct tumour thrombus: A propensity score matched study

et al. 2020

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“…HCC can rarely invade biliary ducts, both microscopically and macroscopically [59]. Incidence of biliary duct invasion ranges from 1.2 to 9%.…”

Section: Liver Disease and Surgerymentioning

confidence: 99%

“…Several studies have shown that biliary ducts invasion in HCC is not a contraindication to surgical resection, even in patients with obstructive jaundice caused by biliary tumor thrombus, as long as R0 resection can be achieved. If jaundice is present, biliary drainage should be performed preoperatively [59,[61][62][63].…”

Section: Liver Disease and Surgerymentioning

confidence: 99%

HCC in Cirrhotic and Non-cirrhotic Liver: Timing to Surgery and Outcome - State of the Art

Brozzetti¹,

Bini²,

D’Alterio³

et al. 2019

Liver Disease and Surgery [Working Title]

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In this chapter we aim at presenting the state of the art in liver surgery. After a brief introduction about natural evolution of hepatocellular carcinoma (HCC) either in cirrhotic or non-cirrhotic patients, this manuscript will focus on planning and timing surgery: CT evaluation of the remnant liver; biopsy and ultrasonography (US) evaluation of liver disease; intraoperative US; surgical techniques, such as major and limited hepatectomies and two-stage hepatectomies, each of them in open or mini-invasive approach; and their possible complications. Follow-up and further interventions during expected recurrences will be highlighted. Our chapter will also treat topics such as patient's quality of life, importance of multidisciplinary evaluation and the role of surgeon in it.

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“…This has been proven by different retrospective studies and meta-analyses. 2,[4][5][6][7][8][9][10] The median survival of patients with BDTT is 1.6-4.3 months with conservative management. 11,12 Surgical resection is the most commonly used management strategy, which allows radical cure of patients with resectable HCC with BDTT.…”

Section: Introductionmentioning

confidence: 99%

<p>Postoperative Adjuvant Transarterial Chemoembolization Improves Short-Term Prognosis of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Propensity-Score Matching Study</p>

Huang

Lin

Wang

et al. 2020

CMAR

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To evaluate the effect of postoperative adjuvant transarterial chemoembolization (PA-TACE) on the prognosis of hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT). Patients and Methods: This study included 109 patients who underwent R0 resection for HCC with BDTT between January 2008 and December 2017: non-TACE (48) and PA-TACE (61). Propensity-score matching (PSM) was conducted in a 1:1 ratio. Recurrence and overall survival (OS) rates were analyzed using the Kaplan-Meier method. Independent risk factors were identified by univariate and multivariate Cox regression analyses. Subgroup analysis was performed by risk-factor stratification. Results: The recurrence rates in the non-TACE and PA-TACE groups were different at 6 months (50.9% vs 26.9%, P=0.03) before PSM and at 6 months (59.3% vs 26.5%, P=0.02) and 12 months (81.4% vs 37.5%, P=0.022) after PSM. OS rates of the non-TACE and PA-TACE groups were different at 6 months (74.0% vs 91.6%, P<0.001) and 12 months (61.1% vs 77.6%, P=0.01) before PSM and at 6 months (73.0% vs 96.8%, P=0.01), 12 months (52.1% vs 89.6%, P=0.001), and 18 months (33.8% vs 64.4%, P=0.034) after PSM. PA-TACE was an independent prognostic factor for both recurrence and OS before and after PSM. Subgroup analysis showed that patients with no HBV infection, tumors >5 cm, macrovascular invasion, alpha-fetoprotein (AFP) >400 ng/mL, or gamma-glutamyl transferase (GGT) >150 U/L benefited significantly from PA-TACE in terms of recurrence rates (all P<0.05). Patients with no HBV infection, multiple tumors, tumors >5 cm, macrovascular invasion, or AFP >400 ng/mL benefited significantly from PA-TACE in terms of OS (all P<0.05). Conclusion: PA-TACE could prolong the short-term prognosis of HCC with macroscopic BDTT and should be recommended for patients with no HBV infection, multiple tumors, tumors >5 cm, poor differentiation, macrovascular invasion, AFP >400 ng/mL, or GGT >150 U/L.

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Prognostic importance of bile duct invasion in surgical resection with curative intent for hepatocellular carcinoma using PSM analysis

Cited by 15 publications

References 30 publications

Outcomes of resection for hepatocellular carcinoma with macroscopic bile duct tumour thrombus: A propensity score matched study

Outcomes of resection for hepatocellular carcinoma with macroscopic bile duct tumour thrombus: A propensity score matched study

HCC in Cirrhotic and Non-cirrhotic Liver: Timing to Surgery and Outcome - State of the Art

<p>Postoperative Adjuvant Transarterial Chemoembolization Improves Short-Term Prognosis of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Propensity-Score Matching Study</p>

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