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Effect of Biliary Tract Invasion with Obstructive Jaundice on the Prognosis of Patients With Unresectable Hepatocellular Carcinoma

  • Author Footnotes
    # Weiwei Jiang and Xiaobo Fu contributed equally to this work.
    Weiwei Jiang
    Footnotes
    # Weiwei Jiang and Xiaobo Fu contributed equally to this work.
    Affiliations
    Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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  • Author Footnotes
    # Weiwei Jiang and Xiaobo Fu contributed equally to this work.
    Xiaobo Fu
    Footnotes
    # Weiwei Jiang and Xiaobo Fu contributed equally to this work.
    Affiliations
    Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
    Search for articles by this author
  • Guobao Wang
    Affiliations
    Department of Endoscopy, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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  • Han Qi
    Affiliations
    Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
    Search for articles by this author
  • Zixiong Chen
    Affiliations
    Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
    Search for articles by this author
  • Fei Gao
    Correspondence
    Address correspondence to: F.G.
    Affiliations
    Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
    Search for articles by this author
  • Author Footnotes
    # Weiwei Jiang and Xiaobo Fu contributed equally to this work.
Published:September 20, 2022DOI:https://doi.org/10.1016/j.acra.2022.08.010

      Rationale and Objectives

      Biliary tract invasion (BTI) is associated with poor outcomes in patients with hepatocellular carcinoma (HCC). However, the presence of a BTI is a neglected variable for staging in the current guidelines. This study aimed to explore the effects of BTI with obstructive jaundice on the prognosis of patients with unresectable HCC.

      Methods

      We retrospectively included 205 patients initially diagnosed with unresectable HCC who presented with obstructive jaundice due to BTI between January 2010 and June 2021. BTI was classified into four types according to the location of the biliary obstruction. Both clinical and treatment factors that affect median overall survival (mOS) were analyzed.

      Results

      The mOS of patients with Barcelona Clinic Liver Cancer (BCLC) stages B, C, and D was 9.2 months, 3.4 months, and 1.8 months, respectively (p<.001). The mOS of BTI type I patients was superior to that of BTI type II patients (7.1 months vs. 3.2 months, p=.002). Patients who underwent successful biliary drainage had a longer mOS than those who underwent unsuccessful biliary drainage (10.4 months vs. 2.9 months, p<.001). In the multivariate analysis, BTI type I (p=.009), successful biliary drainage (p=.005), and HCC treatment (p<.001) were significant favorable prognostic factors that affected patient survival.

      Conclusion

      HCC patients with BTI type II may have a poorer prognosis than those with BTI type I.
      Effective biliary drainage and anti-cancer treatment may provide survival benefits to these patients. A more detailed staging system for HCC based on the state of BTI is needed.

      Key Words

      Abbreviations:

      HCC (Hepatocellular carcinoma), PVTT (Portal vein tumor thrombus), BTI (Biliary tract invasion), TACE (Transcatheter arterial chemoembolization), BCLC (Barcelona Clinic Liver Cancer staging system), NCCN (The National Comprehensive Cancer Network), AJCC (American Joint Committee on Cancer), ASSLD (American Association for the Study of Liver Disease), EASL (European Association for the Study of the Liver), mOS (median Overall survival), HR (Hazard ratio)
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