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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 20, 2022
Accepted:
August 6,
2022
Received in revised form:
August 3,
2022
Received:
June 15,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
