Abstract
To clarify the characteristics of hepatocellular carcinoma (HCC) with bile duct invasion, we retrospectively analyzed clinical features and surgical outcome of HCC with bile duct invasion (b+ group, n = 15) compared to those without bile duct invasion (b− group, n = 256). In the b+ group, four patients (27%) showed obstructive jaundice, and a diagnosis of bile duct invasion was obtained preoperatively in seven patients (47%). The levels of serum bilirubin and carbohydrate antigen 19–9 were significantly higher in the b+ group. Macroscopically, confluent multinodular type and infiltrative type were predominant in the b+ group (P = 0.002). Microscopically, capsule infiltration (P = 0.040) and intrahepatic metastasis (P = 0.013) were predominant in the b+ group. Portal vein invasion was associated significantly with the b+ group (P = 0.004); however, the frequency of hepatic vein invasion was similar (P = 0.096). The median survival after resection was significantly shorter in the b+ group than in the b− group (11.4 vs. 56.1 months, P = 0.002), and eight of 11 intrahepatic recurrences in the b+ group occurred within 3 months after surgery. HCC with bile duct invasion has an infiltrative nature and a high risk of intrahepatic recurrence, resulting in poor prognosis.
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