Usefulness of resection for hepatocellular carcinoma with macroscopic bile duct tumor thrombus

Background: The prognostic significance of bile duct tumor thrombus (BDTT) in hepatocellular carcinoma (HCC) is unclear and the usefulness of resection for HCC with BDTT is still controversial. The aim of the present study was to evaluate the impact of BDTT on prognosis in HCC and to determine whether resection of HCC with BDTT was useful.

Patients and methods: Out of 820 HCC patients who underwent hepatic resection from 1992 to 2012, 13 HCC patients (1.6%) had macroscopic BDTT. The results of resection for HCC patients with BDTT and the prognostic significance of BDTT were evaluated. Prognoses were also compared according to treatment in patients who had HCC with BDTT.

Results: The overall 1-, 3- and 5-year survival rates after resection were 92%, 77% and 48%, respectively, for HCC patients with BDTT, and 88%, 67%, and 52%, respectively, for HCC patients without BDTT; there were no significant differences (p=0.833). In all HCC patients after resection, the unadjusted hazard ratio of the presence of BDTT was 1.08 (95%CI=0.49-2.05; p=0.835) and when adjusted for other significant prognostic factors, the hazard ratio of the presence of BDTT was 0.98 (95%CI=0.42-1.98; p=0.958). The overall 1-, 3- and 5-year survival rates were 14%, 5% and 0%, respectively, for 25 HCC patients with BDTT after other initial treatments.

Conclusion: Bile duct tumor thrombus was not a prognostic factor in patients with resected HCC. In HCC with BDTT, surgical treatment is recommended whenever possible because only resected patients achieved long-term survival.