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

Chi,Qiyu; Shi,Zheng; Zhang,Zhibo; Zhang,Xiang; Zhang,Li; Weng,Shangeng

doi:10.3892/ol.2020.11979

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

Authors:
- Qiyu Chi
- Zheng Shi
- Zhibo Zhang
- Xiang Zhang
- Li Zhang
- Shangeng Weng
View Affiliations

Affiliations: Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China, Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
Published online on: August 13, 2020 https://doi.org/10.3892/ol.2020.11979
Article Number: 118
Copyright: © Chi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

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.

View Figures

View References

1	Shehta A, Han HS, Yoon YS, Cho JY and Choi Y: Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: 10-year single-center experience. Surg Endosc. 30:638–648. 2016. View Article : Google Scholar : PubMed/NCBI
2	Oba A, Takahashi S, Kato Y, Gotohda N, Kinoshita T, Shibasaki H, Ikeda M and Konishi M: Usefulness of resection for hepatocellular carcinoma with macroscopic bile duct tumor thrombus. Anticancer Res. 34:4367–4372. 2014.PubMed/NCBI
3	Ueda M, Takeuchi T, Takayasu T, Takahashi K, Okamoto S, Tanaka A, Morimoto T, Mori K and Yamaoka Y: Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi. Hepatogastroenterology. 41:349–354. 1994.PubMed/NCBI
4	Kudo M, Izumi N, Ichida T, Ku Y, Kokudo N, Sakamoto M, Takayama T, Nakashima O, Matsui O and Matsuyama Y: Report of the 19th follow-up survey of primary liver cancer in Japan. Hepatol Res. 46:372–390. 2016. View Article : Google Scholar : PubMed/NCBI
5	Nakashima T, Okuda K, Kojiro M, Jimi A, Yamaguchi R, Sakamoto K and Ikari T: Pathology of hepatocellular carcinoma in Japan. 232 consecutive cases autopsied in ten years. Cancer. 51:863–877. 1983. View Article : Google Scholar : PubMed/NCBI
6	Meng KW, Dong M, Zhang WG and Huang QX: Clinical characteristics and surgical prognosis of hepatocellular carcinoma with bile duct invasion. Gastroenterol Res Pract. 2014:6049712014. View Article : Google Scholar : PubMed/NCBI
7	Zeng H, Xu LB, Wen JM, Zhang R, Zhu MS, Shi XD and Liu C: Hepatocellular carcinoma with bile duct tumor thrombus: A clinicopathological analysis of factors predictive of recurrence and outcome after surgery. Medicine (Baltimore). 94:e3642015. View Article : Google Scholar : PubMed/NCBI
8	Shao W, Sui C, Liu Z, Yang J and Zhou Y: Surgical outcome of hepatocellular carcinoma patients with biliary tumor thrombi. World J Surg Oncol. 9:22011. View Article : Google Scholar : PubMed/NCBI
9	Ikenaga N, Chijiiwa K, Otani K, Ohuchida J, Uchiyama S and Kondo K: Clinicopathologic characteristics of hepatocellular carcinoma with bile duct invasion. J Gastrointest Surg. 13:492–497. 2009. View Article : Google Scholar : PubMed/NCBI
10	Yamamoto S, Hasegawa K, Inoue Y, Shindoh J, Aoki T, Sakamoto Y, Sugawara Y, Makuuchi M and Kokudo N: Bile duct preserving surgery for hepatocellular carcinoma with bile duct tumor thrombus. Ann Surg. 261:e123–e125. 2015. View Article : Google Scholar : PubMed/NCBI
11	Xiangji L, Weifeng T, Bin Y, Chen L, Xiaoqing J, Baihe Z, Feng S and Mengchao W: Surgery of hepatocellular carcinoma complicated with cancer thrombi in bile duct: Efficacy for criteria for different therapy modalities. Langenbecks Arch Surg. 394:1033–1039. 2009. View Article : Google Scholar : PubMed/NCBI
12	Lau W, Leung K, Leung TW, Liew CT, Chan MS, Yu SC and Li AK: A logical approach to hepatocellular carcinoma presenting with jaundice. Ann Surg. 225:281–285. 1997. View Article : Google Scholar : PubMed/NCBI
13	Bae SH, Park HC, Yoon WS, Yoon SM, Jung IH, Lee IJ, Kim JW, Seong J, Kim TH, Nam TK, et al: Treatment outcome after fractionated conformal radiotherapy for hepatocellular carcinoma in patients with child-pugh classification B in Korea (KROG 16-05). Cancer Res Treat. 51:1589–1599. 2019. View Article : Google Scholar : PubMed/NCBI
14	Abdel-Rahman O: Assessment of the discriminating value of the 8th AJCC stage grouping for hepatocellular carcinoma. HPB (Oxford). 20:41–48. 2018. View Article : Google Scholar : PubMed/NCBI
15	Edmondson HA and Steiner PE: Primary carcinoma of the liver: A study of 100 cases among 48,900 necropsies. Cancer. 7:462–503. 1954. View Article : Google Scholar : PubMed/NCBI
16	Shiomi M, Kamiya J, Nagino M, Uesaka K, Sano T, Hayakawa N, Kanai M, Yamamoto H and Nimura Y: Hepatocellular carcinoma with biliary tumor thrombi: Aggressive operative approach after appropriate preoperative management. Surgery. 129:692–698. 2001. View Article : Google Scholar : PubMed/NCBI
17	Lee NW, Wong KP, Siu KF and Wong J: Cholangiography in hepatocellular carcinoma with obstructive jaundice. Clin Radiol. 35:119–123. 1984. View Article : Google Scholar : PubMed/NCBI
18	Mok KT, Chang HT, Liu SI, Jou NW, Tsai CC and Wang BW: Surgical treatment of hepatocellular carcinoma with biliary tumor thrombi. Int Surg. 81:284–288. 1996.PubMed/NCBI
19	Satoh S, Ikai I, Honda G, Okabe H, Takeyama O, Yamamoto Y, Yamamoto N, Iimuro Y, Shimahara Y and Yamaoka Y: Clinicopathologic evaluation of hepatocellular carcinoma with bile duct thrombi. Surgery. 128:779–783. 2000. View Article : Google Scholar : PubMed/NCBI
20	Yeh CN, Jan YY, Lee WC and Chen MF: Hepatic resection for hepatocellular carcinoma with obstructive jaundice due to biliary tumor thrombi. World J Surg. 28:471–475. 2004. View Article : Google Scholar : PubMed/NCBI
21	Yang X, Qiu Z, Ran R, Cui L, Luo X, Wu M, Tan WF and Jiang X: Prognostic importance of bile duct invasion in surgical resection with curative intent for hepatocellular carcinoma using PSM analysis. Oncol Lett. 16:3593–3602. 2018.PubMed/NCBI
22	Kim JM, Kwon CH, Joh JW, Sinn DH, Park JB, Lee JH, Kim SJ, Paik SW, Park CK and Yoo BC: Incidental microscopic bile duct tumor thrombi in hepatocellular carcinoma after curative hepatectomy: A matched study. Medicine (Baltimore). 94:e4502015. View Article : Google Scholar : PubMed/NCBI
23	Rammohan A, Sathyanesan J, Rajendran K, Pitchaimuthu A, Perumal SK, Balaraman K, Ramasamy R, Palaniappan R and Govindan M: Bile duct thrombi in hepatocellular carcinoma: Is aggressive surgery worthwhile? HPB (Oxford). 17:508–513. 2015. View Article : Google Scholar : PubMed/NCBI
24	Wong TC, Cheung TT, Chok KS, Chan AC, Dai WC, Chan SC, Poon RT, Fan ST and Lo CM: Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus. HPB (Oxford). 17:401–408. 2015. View Article : Google Scholar : PubMed/NCBI
25	Moon DB, Hwang S, Wang HJ, Yun SS, Kim KS, Lee YJ, Kim KH, Park YK, Xu W, Kim BW, et al: Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: A Korean multicenter study. World J Surg. 37:443–451. 2013. View Article : Google Scholar : PubMed/NCBI
26	Yasunori M and Masatoshi K: Hepatocellular carcinoma with obstructive jaundice: Endoscopic and percutaneous biliary drainage. Dig Dis. 30:592–597. 2012. View Article : Google Scholar : PubMed/NCBI
27	Orimo T, Kamiyama T, Yokoo H, Wakayama K, Shimada S, Tsuruga Y, Kamachi H and Taketomi A: Hepatectomy for hepatocellular carcinoma with bile duct tumor thrombus, including cases with obstructive Jaundice. Ann Surg Oncol. 23:2627–2634. 2016. View Article : Google Scholar : PubMed/NCBI
28	Noda T, Nagano H, Tomimaru Y, Murakami M, Wada H, Kobayashi S, Marubashi S, Eguchi H, Takeda Y, Tanemura M, et al: Prognosis of hepatocellular carcinoma with biliary tumor thrombi after liver surgery. Surgery. 149:371–377. 2011. View Article : Google Scholar : PubMed/NCBI
29	Rubin DB: Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 127:757–263. 1997. View Article : Google Scholar : PubMed/NCBI
30	Austin PC: An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 46:399–424. 2011. View Article : Google Scholar : PubMed/NCBI
31	Cho HJ, Kim SS, Kang SY, Yang MJ, Noh CK, Hwang JC, Lim SG, Shin SJ, Lee KM, Yoo BM, et al: A proposal for modification of the barcelona clinic liver cancer staging system considering the prognostic implication of performance status. Gut Liver. 13:557–568. 2019. View Article : Google Scholar : PubMed/NCBI
32	Vauthey JN, Klimstra D, Franceschi D, Tao Y, Fortner J, Blumgart L and Brennan M: Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. Am J Surg. 169:28–35. 1995. View Article : Google Scholar : PubMed/NCBI
33	Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N and Makuuchi M: Recurrence of hepatocellular carcinoma after surgery. Br J Surg. 83:1219–1222. 1996. View Article : Google Scholar : PubMed/NCBI
34	Esaki M, Shimada K, Sano T, Sakamoto Y, Kosuge T and Ojima H: Surgical results for hepatocellular carcinoma with bile duct invasion: A clinicopathologic comparison between macroscopic and microscopic tumor thrombus. J Surg Oncol. 90:226–232. 2005. View Article : Google Scholar : PubMed/NCBI
35	Han J, Li ZL, Xing H, Wu H, Zhu P, Lau WY, Zhou YH, Gu WM, Wang H, Chen TH, et al: The impact of resection margin and microvascular invasion on long-term prognosis after curative resection of hepatocellular carcinoma: A multi-institutional study. HPB (Oxford). 21:962–971. 2019. View Article : Google Scholar : PubMed/NCBI
36	Shibata T, Yamamoto N, Ikai I, Shimahara Y, Yamaoka Y, Itoh K and Konishi J: Choledochojejunostomy: Possible risk factor for septic complications after percutaneous hepatic tumor ablation. AJR Am J Roentgenol. 174:985–986. 2000. View Article : Google Scholar : PubMed/NCBI
37	Kim DS, Kim BW, Hatano E, Hwang S, Hasegawa K, Kudo A, Ariizumi S, Kaibori M, Fukumoto T, Baba H, et al: Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: A Korea-Japan multicenter study. Ann Surg. 271:913–921. 2020. View Article : Google Scholar : PubMed/NCBI
38	Kojiro M, Kawabata K, Kawano Y, Shirai F, Takemoto N and Nakashima T: Hepatocellular carcinoma presenting as intrabile duct tumor growth: A clinicopathologic study of 24 cases. Cancer. 49:2144–2147. 1982. View Article : Google Scholar : PubMed/NCBI