Prognostic Comparison Between Liver Resection and Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Patients With Bile Duct Tumor Thrombus: A Propensity-Score Matching Analysis.

Chang Liu,Jin-Kai Feng,Wei-Xing Guo,Shu-Qun Cheng,Zong-Tao Chai,Ju-Xian Sun,Jie Shi,Zhen-Hua Chen,Fei-Fei Mao,Shi-Ye Yang,Zong-Han Liu

doi:10.3389/fonc.2022.835559

Abstract

BackgroundHepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The aim of this study is to evaluate the long-term prognosis of liver resection (LR) versus transcatheter arterial chemoembolization (TACE) in these patients.MethodsData from HCC patients with BDTT who underwent liver resection and TACE were analyzed respectively. Propensity score matching (PSM) analysis was performed in these patients.ResultsA total of 145 HCC patients with BDTT were divided into two groups: the LR group (n = 105) and the TACE group (n = 40). The median OS in the LR group was 8.0 months longer than that in the TACE group before PSM (21.0 vs. 13.0 months, P <0.001) and 9.0 months longer after PSM (20.0 vs. 11.0 months, P <0.001). The median DFS in the LR group was 3.5 months longer than that in the TACE group before PSM (7.0 vs. 3.5 months, P = 0.007) and 5 months longer after PSM (7.0 vs. 2.0 months, P = 0.007).ConclusionIf surgery is technically feasible, liver resection provides better prognosis for HCC patients with BDTT compared with TACE.

Highlights

Bile duct tumor thrombus (BDTT) involves invasion of hepatocellular carcinoma (HCC) into the biliary tree [1], and it is relatively uncommon with a reported incidence from 1.2 to 12.9% [2–5]
A total of 145 HCC patients with bile duct tumor thrombus (BDTT) were divided into two groups: the liver resection (LR) group (n = 105) and the transcatheter arterial chemoembolization (TACE) group (n = 40)
If surgery is technically feasible, liver resection provides better prognosis for HCC patients with BDTT compared with TACE

Summary

Introduction

Bile duct tumor thrombus (BDTT) involves invasion of hepatocellular carcinoma (HCC) into the biliary tree [1], and it is relatively uncommon with a reported incidence from 1.2 to 12.9% [2–5]. With a better understanding of BDTT and the progress in diagnosis and surgical techniques, an increasing number of groups evaluated the prognosis of HCC patients with BDTT who underwent liver resection and reported the 3-year survival rates ranging from 24.3 to 77% [11–14], which were higher than those of the conservative therapy. Clinical studies regarding the prognostic difference between liver resection (LR) and TACE for BDTT are limited, while extensive studies have been done in HCC with portal vein tumor thrombosis (PVTT) or hepatic vein tumor thrombus (HVTT) [15, 16]. Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The aim of this study is to evaluate the long-term prognosis of liver resection (LR) versus transcatheter arterial chemoembolization (TACE) in these patients

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