Bile Duct Tumor Thrombus Research Articles

Dose and Location of Irradiation Determine Survival for Patients with Hepatocellular Carcinoma with Macrovascular Invasion in External Beam Radiation Therapy

Aim: Prognosis of hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) is extremely poor. However, proper therapeutic strategies have not been established yet. The purpose of this study is to identify the effects of external beam radiation therapy (EBRT) for MVI of HCC. Methods: We have analyzed and evaluated 80 consecutive patients with HCC with MVI who underwent EBRT, and factors associated with enhanced survival in EBRT were evaluated by univariate and multivariate analysis. Results: The local response rate of radiotherapy for the irradiated MVI was 66.2%. The time to progression of the irradiated MVI was 5.8 months. Univariate and multivariate analyses showed that the higher irradiation dose (over 45 Gy) and the irradiation location (hepatic vein tumor thrombus – HVTT) were significant factors associated with survival benefits of EBRT. The response of EBRT for HVTT was significantly superior to that for portal vein or bile duct tumor thrombus. Conclusion: We conclude that a multidisciplinary therapeutic strategy based on EBRT should be proactively selected in the treatment of advanced HCC with MVI.

The benefits of curative R0 surgical resection with a selective bile duct preserving approach for hepatocellular carcinoma with macroscopic bile duct tumor thrombus: A single center retrospective comparative study

Introduction: Hepatocullular carcinoma (HCC) presenting with macroscopic bile duct tumor thrombus (BDTT) is an uncommon event. The role of curative hepatic resection and associated long-term outcomes remain controversial. In addition, the necessity for bile duct resection is still unclear. The aim of this study was to evaluate outcomes of hepatectomy with a selective bile duct preservation approach for HCC with BDTT in comparison to without BDTT. Method: At our institute, a total of 22 HCC with macroscopic BDTT patients who had undergone curative hepatic resection with a selective bile duct preservation approach. Bile duct resection would be performed when failed tumor thrombectomy or suspected intrahepatic cholangiocarcinoma type III. These were compared to a group of 145 HCC without BDTT patients. The impact of R0 surgical resection and BDTT on clinical outcomes and survival after surgical resection were evaluated. Result: All HCC with BDTT cases underwent major hepatectomy vs 32.4% in the other group. Bile duct preservation rate was 60.8%. The 1, 3 and 5-year survival rates of HCC with BDTT patients compared to the other group were 78.2, 38.1, 26.1% vs 73.6, 55.6, 25.0%, respectively. Regarding multivariate analysis, a tumor size more than five centimeters and venous invasion were independent factors which impacted survival (p-value = 0.001, 0.032). BDTT did not show the impact on recurrence-free survival and overall survival (p-value = 0.073, 0.105). Patients who recieved an R0 resection showed a significantly superior long term outcome regardless of bile duct resection or BDTT status (p-value = 0.001). There was no intraductal recurrence in our series. Conclusion: Bile duct obstruction from tumor thrombus did not necessarily indicate an advanced form of the disease. A selective bile duct preservation approach showed comparable outcomes. In selected patients a proper hepatic resection with a negative margin can improve survival regardless of BDTT status.

Surgical Treatment on Hepatocellular Carcinoma(HCC) with Bile Duct Tumor Thrombi

Surgical Treatment on Hepatocellular Carcinoma(HCC) with Bile Duct Tumor Thrombi

Meta-analysis of concurrent hepatectomy with extrahepatic bile duct resection in hepatocellular carcinoma patients with bile duct tumor thrombi

Meta-analysis of concurrent hepatectomy with extrahepatic bile duct resection in hepatocellular carcinoma patients with bile duct tumor thrombi

Meta-analysis of concurrent hepatectomy with extrahepatic bile duct resection in hepatocellular carcinoma patients with bile duct tumor thrombi

Meta-analysis of concurrent hepatectomy with extrahepatic bile duct resection in hepatocellular carcinoma patients with bile duct tumor thrombi

Comparative clinical outcomes of liver resection for hepatocellular carcinoma with and without bile duct tumor thrombus: single centre experience

Introduction: Hepatocullular carcinoma(HCC) presenting with obstructive juandice caused by bile duct tumor thrombus(BDTT) is an uncommon event. The role of hepatectomy and clinical outcomes are remaining controversy. The aim of this study was to evaluate clinical outcomes after hepatectomy for HCC with BDTT comparing to non-BDTT. Methods: 22 HCC patients with BDTT who underwent hepatectomy were retrospective reviewed of shot and long-term outcomes comparing with 111 HCC patients without BDTT. An impacted of BDTT to clinical outcome and survival benefit after surgical resection was analyzed. Results: HCC with BDTT group presenting with higher level of serum total bilirubin, alpha-fetoprotein and CA 19-9. Six HCC patients with BDTT (26.1%) received preoperative percutaneous transhepatic biliary drainage(PTBD). All HCC with BDTT cases received major hepatectomy VS 32.4% in non-BDTT group. The HCC patients with BDTT who underwent hepatectomy have longer operative time (420 VS 217 minute), more blood loss (1,200 VS 500 ml) and higher morbidity(53.5% VS 16.7%). The 1-, 3- and 5-year survival rates of BDTT group were 85.7%, 71.4%, and 71.4%, respectively. These were slightly lower than non-BDTT group (97.3%, 82.9%, and 81.1%, respectively) but no statistical significant (P-value = 0.208). BDTT was not showed impact to survival and recurrence (P-value = 0.608, 0.807).Tabled 1EP01C-011 Table [Univariate and multivariate analysis for survival]Prognostic factorsNo. of patients, n (%)Univariable analysisp-valueMultivariable analysisp-valueCrude HR (95%CI)Adjusted HR (95%CI)Bile duct tumor thrombusYes21 (15.9)1.78 (0.72-4.40)0.2141.28 (0.50-3.29)0.608No111 (84.1)1.001.00Largest tumor diameter (cm)≥ 561 (46.2)2.68 (1.20-5.97)0.0162.74 (1.21-6.18)0.015< 571 (53.8)1.001.00Margin positive21 (15.9)2.21 (0.93-5.22)0.072Margin negative111 (84.1)1.00 Open table in a new tab Conclusions: Bile duct obstruction from tumor thrombus does not imply as an advanced disease. HCC with BDTT patients can achieve favorable surgical outcomes and long term survival after liver resection when appropriate operation is carefully selected.

Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: A Korea-Japan multicenter study

Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: A Korea-Japan multicenter study

Extrahepatic bile duct resection in patients with hepatocellular carcinoma with bile duct tumor thrombi

Objective To review the role of extrahepatic bile duct resection in patients with hepatocellular carcinoma with bile duct tumor thrombi. Methods The Pubmed, Wan Fang and China Science and Technology Journal Database were reviewed systematically. Any case reports or studies involving treatment of hepatocellular carcinoma with bile duct tumor thrombi were included in this literature search. Two authors independently assessed the studies for inclusion and extracted the data. Univariate analysis was used to compare the baseline characteristics and the Kaplan-Meier method was used for analyzing survival and disease-free survival outcomes. Results Using predetermined inclusion criteria, 16 studies which included 170 patients entered into this study. All these patients underwent surgical resection of hepatocellular carcinoma and bile duct tumor thrombi. Based on the Satoh classification, 45 patients were type Ⅰ, 107 patients type Ⅱ and 18 patients type Ⅲ. Twenty-four patients underwent liver resection combined with extrahepatic bile duct resection. The remaining 146 patients underwent liver resection combined with thrombectomy. The 1-, 3-, and 5-year survival rates of all the patients were 73.4%, 41.5% and 21.8%, and the corresponding recurrences free survival rates were 62.5%, 29.2% and 13.1%, respectively. On Kaplan-Meier analysis, there were no significant differences in the survival outcomes between the 2 groups of patients, (P>0.05). The 1-, 3-, and 5-year survival rates of the extrahepatic bile duct resection group were 66.7%, 41.7% and 12.5%, and those of the thrombectomy group were 74.6%, 41.3% and 23.8%, respectively. On subgroup analysis (Satoh type Ⅱ and Ⅲ), no significant differences were observed between the two groups (P>0.05). The 1-, 3-, and 5-year survival rates of the extrahepatic bile duct resection group were 65.2%, 38.0% and 13.0%, and those of the thrombectomy group were 72.8%, 39.5% and 20.9%, respectively. Conclusion Extrahepatic bile duct resection did not improve the overall survival of patients with hepatocellular carcinoma with bile duct tumor thrombi. Key words: Carcinoma, hepatocellular; Bile duct tumor thrombi; Hepatectomy; Thrombectomy; Extrahepatic bile duct resection

Surgical effect analysis of hepatocellular carcinoma with different lymphovascular invasion

Objective To compare the clinical features and surgical outcomes of hepatocellular carcinoma (HCC) combined with portal venous tumor thrombus (PVTT) and hepatic venous tumor thrombus (HVTT) or bile duct tumor thrombi (BDTT), and analyze the effects of different tumor thrombus (TT) types and different surgical methods for TT on prognosis. Methods The retrospective cross-sectional study was conducted. The clinical data of 220 HCC patients with lymphovascular invasion (LVI) who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University between January 2004 and December 2014 were collected. Of 220 patients, 140 were combined with PVTT, 36 with HVTT and 44 with BDTT. According to patients′ conditions, they underwent tumor and TT resection, and tumor resection + TT removal or single TT removal. Observation indicators: (1) comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT; (2) surgical and postoperative situations; (3) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 2015. Measurement data with normal distribution were represented as ±s. Comparisons among 3 indicators were analyzed using the one-way ANOVA, and comparisons between 2 indicators were analyzed using the t test. Comparisons of count data were analyzed using the chi-square test. The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method, and the Log-rank test was used for survival analysis. Results (1) Comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT: number of patients with Child-pugh A, Child-pugh B and peritoneal effusion, tumor diameter and cases with tumor capsule were respectively detected in 133, 7, 23, (10±4)cm, 91 in HCC patients with PVTT and 35, 1, 4, (9±4)cm, 27 in HCC patients with HVTT and 35, 9, 16, (6±4)cm, 15 in HCC patients with BDTT, with statistically significant differences (χ2=12.693, 10.408, F=11.300, χ2=17.188, P 0.05). ④ Of 44 HCC patients with BDTT, 24, 6 and 14 were respectively detected in type Ⅰ, Ⅱ and Ⅲ BDTTs, and median survival time, 1-, 3- and 5-year survival rates were respectively 38 months, 87.5%, 60.4%, 34.9% in type Ⅰ BDTT patients and 26 months, 83.3%, 16.7%, 0 in type Ⅱ BDTT patients and 35 months, 78.6%, 50.0%, 21.4% in type Ⅲ BDTT patients, showing no statistically significant difference in survival (χ2=5.312, P>0.05). Of 44 patients, median survival time, 1-, 3- and 5-year survival rates were respectively 38 months, 91.3%, 59.5%, 34.3% in 23 patients undergoing tumor and TT resection and 26 months, 85.7%, 35.7%, 15.3% in 21 patients undergoing tumor resection + TT removal through incising common bile duct, showing no statistically significant difference in survival (χ2=2.071, P>0.05). Conclusions HCC patients with PVTT have larger tumor diameter and worse liver dysfunction, and are prone to peritoneal effusion. HCC patients with different LVI undergo surgery. There is better prognosis in HCC patients with BDTT, and good prognosis in patients with HVTT, while poorer prognosis in patients with PVTT. The postoperative survival of HCC patients with PVTT is associated with TT type, and patients will have better prognosis after tumor resection + TT removal if TT type is confirmed earlier. The postoperative survival of HCC patients with BDTT is not associated with TT type, tumor resection + TT removal maybe prolong postoperative survival time. Key words: Carcinoma, hepatocellular; Portal venous tumor thrombus; Hepatic venous tumor thrombus; Bile duct tumor thrombus; Surgical procedures, operative; Prognosis; Overall survival rate

Small molecule metabolite biomarkers for hepatocellular carcinoma with bile duct tumor thrombus diagnosis

Hepatocellular carcinoma with bile duct tumor thrombus (BDTT) is a malignant disease. The most commonly used diagnosis methods for BDTT are MRCP/ERCP, ultrasonic diagnosis or CT scan. However, BDTT is often misdiagnosed as other bile duct diseases, such as extrahepatic cholangiocarcinoma (EHCC), choledochal cyst (Cyst) and common bile duct stone (Stone). Diagnostic methods, which are more accurate and less destructive, are urgently needed. In this paper, we analyzed the small molecule metabolites in the serum of BDTT, Stone, Cyst and EHCC patients and normal people using untargeted GC-MS, and identified 21 metabolites that show different levels among different samples. Using targeted UHPLC-QQQ-MS analysis, we found that several metabolites are significantly changed. ROC curve analysis revealed two metabolites, L-citrulline and D-aspartic acid, as potential biomarkers that can distinguish BDTT from other bile duct diseases.

Surgical treatment of hepatocellular carcinoma with advanced portal vein tumor thrombus combined with pre-operative radiotherapy.

385 Background: Hepatocellular carcinoma (HCC) with advanced portal vein tumor thrombus (PVTT) in the main portal trunk (MPT) or the first branch of portal vein has poor prognosis. We attempted a multidisciplinary treatment to irradiate the PVTT prior to surgical resection. In this study, we evaluate the therapeutic effect of preoperative radiotherapy (Pre-RT) for HCC with advanced PVTT. Methods: The postoperative prognosis was retrospectively examined in 75 patients with advanced PVTT out of 1,045 patients who underwent hepatectomy for HCC between 1990 and 2015 in our institute. The treatment outcome was compared between the patients who underwent Pre-RT (30Gy/10fr) for PVTT before operation (RT group, n = 34) and patients not underwent Pre-RT (non-RT group, n = 41). Results: Among 75 patients with advanced PVTT, there was no difference in age, sex, extent of PVTT (MPT or first branch of PV), HBV, HCV, T-Bil, PT(%), ICG R15%, Child-Pugh classification, AFP, DCP, intra-operative blood loss, tumor size, tumor number, coexisting hepatic vein or bile duct tumor thrombus, presence of the residual tumor between RT and non-RT group other than adjuvant chemotherapy administration (p = 0.0009). The 5-year overall survival rate of all 75 cases was 18.5%. There was a significant overall survival extension in RT group with 29.4% compared to 16.2% in non-RT group (p = 0.039, log-rank test). Surgery without residual lesions was performed in 64 patients, of which the 5-year recurrence-free survival rate was 10.9%. The 5-year recurrence-free survival rate of RT group (n = 30) (16.1%) was significantly better than non-RT group (n = 34) (5.5%) (p = 0.027, log-rank test). Univariate analysis using Cox proportional hazard model demonstrated that the Pre-RT was the only significant prognostic factor (HR 0.595, 95% CI 0.356 - 0.981, p = 0.042) for overall survival, and the Pre-RT and tumor size over 10cm for recurrence-free survival among these patient’s factors. Conclusions: Multidisciplinary treatment combined preoperative radiotherapy to PVTT and subsequent surgical resection improve the prognosis for the patients of HCC with advanced PVTT extend to MPT or first branch of PV.

Advances in Surgical Research of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus

Advances in Surgical Research of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus

Gallbladder carcinoma with tumor thrombus in the common bile duct: a case report

Gallbladder carcinoma with tumor thrombus in the common bile duct: a case report

Hepatocellular Carcinoma with Bile Duct Tumor Thrombi (Icteric Hepatoma)– A 19 Year Experience from a Tertiary Care Centre

Hepatocellular Carcinoma with Bile Duct Tumor Thrombi (Icteric Hepatoma)– A 19 Year Experience from a Tertiary Care Centre

Prognosis of hepatocellular carcinoma patients with bile duct tumor thrombus after hepatic resection or liver transplantation in Asian populations: A meta-analysis.

BackgroundHepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) in the clinic is rare, and surgical treatment is currently considered the most effective treatment. However, the influence of BDTT on the prognosis of HCC patients who underwent surgery remains controversial in previous studies. Therefore, this paper uses meta-analysis method to elucidate this controversy.MethodsIn this study, we conducted a literature search on databases PubMed, Embase and Web of Science from inception until September 2016. Each study was evaluated with Newcastle-Ottawa Scale (NOS). The pooled effect was calculated, and the association between BDTT and overall survival (OS) or disease-free survival (DFS) was reevaluated using meta-analysis for hazard ratio (HR) and 95% confidence interval (CI).ResultsA total of 11 studies was included containing 5295 patients. The (HR) for OS and DFS was 3.21 and 1.81, 95%CI was 2.34–4.39 and 1.17–2.78 respectively.ConclusionsThe results showed that HCC patients with BDTT had a worse prognosis than those without BDTT after hepatic resection or liver transplantation (LT).

A single institution report of 19 hepatocellular carcinoma patients with bile duct tumor thrombus.

BackgroundObstructive jaundice caused due to bile duct tumor thrombus (BDTT) in a hepatocellular carcinoma (HCC) patient is an uncommon event. This study reports our clinical experiences and evaluates the outcomes of HCC patients with BDTT in a single institution.MethodsA retrospective review of 19 HCC patients with secondary obstructive jaundice caused due to BDTT during a 15-year period was conducted.ResultsAt the time of diagnosis, 14 (73.7%) patients had obstructive jaundice. Eighteen (94.7%) patients were preoperatively suspected of “obstruction of the bile duct”. Sixteen patients (84.2%) underwent a hepatectomy with curative intent, while two patients underwent removal of BDTT combined with biliary decompression and another patient received only palliative care as his liver reserve and general condition could not tolerate the primary tumor resection. The overall early recurrence (within 1 year) after hepatectomy occurred in more than half (9/16, 56.3%) of our patients. The 1-year survival rate of patients was 75% (12/16). The longest disease-free survival time was >11 years.ConclusionIdentification of HCC patients with obstructive jaundice is clinically important because proper treatment can offer an opportunity for a cure and favorable long-term survival.

Prognosis of Asian patients with hepatocellular carcinoma with bile duct tumor thrombus after hepatic resection or liver transplantation: a Meta-analysis

Objective Hepatocellular carcinoma with bile duct tumor thrombus (BDTT) is rare, and surgical treatment is currently considered as the most effective treatment. Whether resectional surgery should be carried out on these patients remains controversial. Therefore, this Meta-analysis aimed to find out the long-term survival after resectional surgical treatment. Methods We conducted a literature search on PubMed, Embase and Web of Science from inception to September 2016. 11 studies were included which involved 5295 patients. Each study was evaluated using the Newcastle-Ottawa Scale. The pooled effect was calculated and the associations between BDTT and overall survival (OS) or disease-free survival (DFS) were reevaluated using Meta-analysis with hazard ratio (HR) and 95% confidence interval (CI). Results The HR for OS and DFS was 2.34 and 1.81, the 95% CI were 1.26~4.36 and 1.17~2.78, respectively. Conclusion HCC patients with BDTT had a bad prognosis after hepatic resection or liver transplantation. Key words: Hepatocellular carcinoma; Bile duct tumor thrombus; Prognosis; Hepatectomy; Liver transplantation; Asian

Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection: a matched study

Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The present study aimed to determine post-surgical prognoses in HCC patients with BDTT, as outcomes are currently unclear. We compared the prognoses of 110 HCC patients without BDTT (group A) to 22 cases with BDTT (group B). The two groups were matched in age, gender, tumor etiology, size, number, portal vascular invasion, and TNM stage. Additionally, 28 HCC patients with BDTT were analyzed to identify prognostic risk factors. The 1-, 3-, and 5-year overall survival rates were 90.9%, 66.9%, and 55.9% for group A and 81.8%, 50.0%, and 37.5% for group B, respectively. The median survival time in groups A and B was 68.8 and 31.4 months, respectively (P=0.043). The patients for group B showed higher levels of serum total bilirubin, alanine aminotransferase and gamma-glutamyl transferase, a larger hepatectomy range, and a higher rate of anatomical resection. In subgroup analyses of patients with BDTT who underwent R0 resection, TNM stage III-IV was an independent risk factor for overall survival; these patients had worse prognoses than those with TNM stage I-II after R0 resection (hazard ratio=6.056, P=0.014). Besides, univariate and multivariate analyses revealed that non-R0 resection and TNM stage III-IV were independent risk factors for both disease-free survival and overall survival of 28 HCC patients with BDTT. The median overall survival time of patients with BDTT who underwent R0 resection was longer than that of patients who did not undergo R0 resection (31.0 vs 4.0 months, P=0.007). R0 resection prolonged survival time in HCC patients with BDTT, although prognosis remains poor. For such patients, R0 resection is an important treatment that determines long-term survival.

Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice.

This study aimed to evaluate the short- and long-term outcomes of hepatectomy for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT), including cases with obstructive jaundice. The study reviewed 42 HCC patients with BDTT, including six patients who needed preoperative biliary drainage due to obstructive jaundice, and 732 HCC patients without BDTT. The authors analyzed the impact of BDTT on the surgical outcomes and assessed the outcomes of hepatectomy for patients presenting with obstructive jaundice. The HCC patients with BDTT, almost all with stage 3 or 4 disease, had increased alpha-fetoprotein expression, larger tumors, and more portal vein invasion status. The survival of the HCC patients with BDTT was significantly inferior to that of the patients without BDTT (p=0.0003). Survival did not differ significantly between the HCC patients with BDTT and those without BDTT when the two groups were matched by stage (p=0.3366). The HCC patients with BDTT who presented with obstructive jaundice demonstrated outcomes similar to those for the HCC patients with BDTT who did not present with obstructive jaundice in terms of the overall survival rate (p=0.5469). The perioperative outcomes for the HCC patients with BDTT did not depend on the presence or absence of preoperative jaundice. No patients in either BDTT group demonstrated 90-day mortality in this study. Hepatectomy should be considered for HCC patients with BDTT, even for patients with obstructive jaundice, because the surgical outcomes equivalent to those for HCC without BDTT can be achieved.

Dysregulation of Bmi1 promotes malignant transformation of hepatic progenitor cells.

Adult hepatic progenitor cells (HPCs) are involved in a wide range of human liver diseases, including hepatocellular carcinoma (HCC). Bmi1 has been reported to have vital roles in stem cell self-renewal and carcinogenesis. We have previously demonstrated that Bmi1 is upregulated in HCC with bile duct tumor thrombi, a subtype of HCC characterized by profuse expression of hepatic stem cell markers. However, the function of Bmi1 in HPCs has not yet been well elucidated. The current study was designed to investigate the effects of Bmi1 on the biological properties of rat HPCs. To accomplish this, Bmi1 was silenced or enhanced in two HPC cell lines (WB-F344 and OC3) by, respectively, using either small interfering RNA against Bmi1 or a forced Bmi1 expression retroviral vector. The biological functions of Bmi1 in HPCs were investigated through cell proliferation assays, colony-formation assays, cell cycle analysis and invasion assays, as well as through xenograft-formation assays. In this study, genetic depletion of Bmi1 repressed cell proliferation, colony formation and invasion in both assessed HPC cell lines relative to controls. Conversely, forced expression of Bmi1 in two HPCs cell lines promoted cell proliferation, colony formation and invasion in vitro. Aldehyde dehydrogenase (ALDH) assay revealed a significant increase in the number of ALDH-positive cells following the forced expression of Bmi1 in HPCs. Most importantly, transplantation of forced Bmi1 expression HPCs into nude mice resulted in the formation of tumors with histological features of poorly differentiated HCC. Taken together, our findings indicate that forced expression of Bmi1 promotes the malignant transformation of HPCs, suggesting Bmi1 might be a potential molecular target for the treatment of HCC.