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Yu X, Liang QZ, Wang JL, Pei YC, Cai JP, Chen LH, Liu Q, Lan T, Chen W, Liang LJ. Effect of bile duct resection on the prognosis of patients with hepatocellular carcinoma combined with extrahepatic bile duct tumor thrombus. BMC Cancer 2024; 24:969. [PMID: 39112950 PMCID: PMC11308446 DOI: 10.1186/s12885-024-12717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Surgical therapy is the most optimal treatment for hepatocellular carcinoma (HCC) combined with bile duct tumor thrombus (BDTT) patients. However, whether to perform bile duct resection (BDR) is still controversial. The purpose of this multicenter research is to compare the effect of BDR on the prognosis of extrahepatic BDTT patients. METHODS We collected the data of 111 HCC patients combined with extrahepatic BDTT who underwent radical hepatectomy from June 1, 2004 to December 31, 2021. Those patients had either received hepatectomy with extrahepatic bile duct resection (BDR group) or hepatectomy without bile duct resection (NBDR group). Inverse probability of treatment weighting (IPTW) was used to reduce the potential bias between two groups and balance the influence of confounding factors in baseline data. Then compare the prognosis between the two groups of patients. Cox regression model was used for univariate and multivariate analysis to further determine the independent risk factors that influence the prognosis of HCC-BDTT patients. RESULTS There were 38 patients in the BDR group and 73 patients in the NBDR group. Before and after IPTW, there were no statistical significance in OS, RFS and intraoperative median blood loss between the two groups (all P > 0.05). Before IPTW, the median postoperative hospital stay in the NBDR group was shorter (P = 0.046) and the grade of postoperative complications was lower than BDR group (P = 0.014). After IPTW, there was no difference in postoperative hospital stay between the two groups (P > 0.05). The complication grade in the NBDR group was still lower than that in the BDR group (P = 0.046). The univariate analysis showed that TNM stage and portal vein tumor thrombus (PVTT) were significantly correlated with OS (both P < 0.05). Preoperative AFP level, TNM stage and prognostic nutritional index (PNI) were significantly correlated with postoperative RFS (all P < 0.05). Multivariate analysis showed that tumor TNM stage was an independent risk factor for the OS rate (P = 0.014). TNM stage, PNI and AFP were independent predictors of RFS after radical hepatectomy (all P < 0.05). CONCLUSIONS For HCC-BDTT patients, hepatocellular carcinoma resection combined with choledochotomy to remove the tumor thrombus may benefit more.
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Affiliation(s)
- Xi Yu
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Qi-Zhi Liang
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Jun-Long Wang
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Yu-Chen Pei
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Jian-Peng Cai
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Liu-Hua Chen
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Qi Liu
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Tian Lan
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
| | - Wei Chen
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China.
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China.
| | - Li-Jian Liang
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Department of Pancreatobiliary, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangdong, 510080, Guangzhou, China
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Feng JK, Chen ZH, Wu YX, Wang K, Sun JX, Chai ZT, Guo WX, Shi J, Cheng SQ. Comparison of different surgical interventions for hepatocellular carcinoma with bile duct tumor thrombus: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1567. [PMID: 33437766 PMCID: PMC7791268 DOI: 10.21037/atm-20-3935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The optimal surgical modality for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) remains controversial, especially regarding deciding whether to perform concurrent bile duct resection (BDR). Methods PubMed, EMBASE, Cochrane Library, Web of Science and Scopus databases were systematically searched from inception to February 2020, in order to compare overall survival (OS) and recurrence-free survival (RFS) rates of HCC patients with BDTT who had either received hepatectomy with extrahepatic bile duct resection (BDR group) or hepatectomy without bile duct resection (NBDR group). Relevant outcomes were extracted by two investigators. Results A total of 12 studies involving 355 patients was included. The 1-, 3- and 5-year OS rates were similar in the BDR and NBDR groups (OR =0.58, 95% CI: 0.31-1.09, P=0.09; OR =0.74, 95% CI: 0.43-1.28, P=0.28; OR =0.63, 95% CI: 0.36-1.11, P=0.11, respectively). However, the BDR group had better 1-, 3- and 5-year RFS rates than the NBDR group (OR =0.38, 95% CI: 0.22-0.65, P<0.01; OR =0.40, 95% CI: 0.22-0.72, P<0.01; OR =0.37, 95% CI: 0.19-0.71, P<0.01, respectively). Conclusions Concomitant bile duct resection results in decreased postoperative recurrence in HCC patients with BDTT. However, the OS rates were similar whether or not patients underwent bile duct resection.
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Affiliation(s)
- Jin-Kai Feng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zhen-Hua Chen
- Department of General Surgery, Zhejiang Provincial Armed Police Corps Hospital, Hangzhou, China
| | - Yu-Xuan Wu
- School of Basic Medicine, Second Military Medical University, Shanghai, China
| | - Kang Wang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Ju-Xian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zong-Tao Chai
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus: A Korea-Japan Multicenter Study. Ann Surg 2020; 271:913-921. [PMID: 30216223 DOI: 10.1097/sla.0000000000003014] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT). SUMMARY BACKGROUND DATA Prognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports. METHODS Records of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model. RESULTS Curative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P < 0.001) and the presence of fibrosis/cirrhosis (P = 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99); P = 0.044 and HR = 0.51 (0.31-0.84); P = 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91); P = 0.018 and HR = 0.61 (0.42-0.89); P = 0.009, respectively]. CONCLUSIONS Clinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.
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Lu WP, Tang HW, Yang ZY, Jiang K, Chen YL, Lu SC. A proposed modification for the Barcelona Clinic Liver Cancer staging system: Adding bile duct tumor thrombus status in patients with hepatocellular carcinoma. Am J Surg 2020; 220:965-971. [PMID: 32336518 DOI: 10.1016/j.amjsurg.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Barcelona Clinic Liver Cancer (BCLC) staging system is widely applied to stage hepatocellular carcinoma (HCC). However, it may be inaccurate when applied to East Asian HCC patients. In this study, a large Chinese HCC cohort was analyzed to evaluate possible modifications for the BCLC staging system. METHODS Between January 1995 and December 2009, 622 HCC patients who underwent hepatectomy were enrolled. Prognostic risk factors were analyzed using univariate and multivariate analyses. The ability of the modified system to predict survival was evaluated by determining the area under the receiver operating characteristic curve. RESULTS Patients without bile duct tumor thrombus (BDTT; 1-, 3- and 5-year overall survival, 80%, 60% and 48%, respectively) showed a substantial survival advantage over those with BDTT (1-, 3- and 5-year overall survival, 77%, 42% and 23%, respectively; χ2 = 6.280, P = 0.012). In BCLC stage 0-A patients, significant differences were identified between the BDTT group and the non-BDTT group, while no such differences were found in BCLC stage B patients. Based on this finding, BCLC stage 0-A BDTT patients were recategorized into stage B. The modified BCLC classification featured better performance in the prediction of overall survival than the original system (modified BCLC χ2 = 53.596, P < 0.001; original BCLC χ2 = 46.335, P < 0.001). The ability to predict mortality was also slightly higher using the modified BCLC system. CONCLUSIONS Modification of the BCLC system to include BDTT status might further enhance its prognostic ability.
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Affiliation(s)
- Wen-Ping Lu
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Hao-Wen Tang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Zhan-Yu Yang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Kai Jiang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yong-Liang Chen
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shi-Chun Lu
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
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