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

Abstract

Background/Aims: The treatments and outcomes of hepatocellular carcinoma (HCC) with bile duct invasion are not well known. We aimed to confirm the safety of transarterial chemolipiodolization (TACL) and identify prognostic factors for patients with bile duct invasion treated with TACL.Methods: Fifty patients with central bile duct invasion treated with TACL between 2005 and 2017 were enrolled. Patients were divided into three groups: hyperbilirubinemia (total bilirubin ≥2.5 mg/dL) with pre-TACL biliary drainage, hyperbilirubinemia without biliary drainage, and without hyperbilirubinemia. Tumor response to TACL, survival outcomes, length of hospitalization, adverse events using Common Terminology Criteria for Adverse Events (CTCAE), and factors affecting overall survival were compared.Results: TACL-induced changes of mean CTCAE grades for albumin, alanine aminotransferase, creatinine, prothrombin time, and platelet were not significantly different among patients with or without initial hyperbilirubinemia. Serum bilirubin level was not significantly changed after TACL in all the three groups. Overall survival was not significantly different among the three groups (P=0.097). On multivariate analysis, alpha-fetoprotein <400 ng/dL (hazard ratio [HR]=0.477, P=0.048) and highest total bilirubin level of <2.5 mg/dL within one month after TACL (HR=0.335, P=0.004) were significantly associated with longer survival. Conclusions: TACL was a safe treatment for HCC patients with central bile duct invasion, irrespective of the presence of initial hyperbilirubinemia. (J Liver Cancer 2018;18:121-129)

Proton Beam Therapy in Managing Unresectable Hepatocellular Carcinoma with Bile Duct Invasion

“…Aside from survival results, tumor response rate and local recurrence rate also achieved desirable goals in this study. Upon first post-treatment imaging evaluation, historical data of TACE provided only 2–4%, 21–38%, and 24–37% in CR, PR, and progressive disease (PD) rates separately [ 3 , 28 , 29 , 35 ]. The current study showed that the first post-treatment imaging evaluation’s CR, PR, and SD rates were 20%, 65%, and 15%, respectively.…”