Skip to main content
SpringerLink
Log in

Impact of Bile Duct Tumor Thrombus on the Long-Term Surgical Outcomes of Hepatocellular Carcinoma Patients: A Propensity Score Matching Analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 22 January 2022

This article has been updated

Abstract

Background

Hepatectomy with tumor thrombectomy is the preferred treatment option for hepatocellular carcinoma (HCC) patients with bile duct tumor thrombus (BDTT); however, the impact of BDTT on their prognosis is unclear.

Objective

We aimed to investigate the long-term surgical outcomes of HCC patients with BDTT.

Methods

The data of HCC patients with and without BDTT who underwent hepatectomy were retrospectively reviewed and the long-term outcomes were compared. For propensity score matching (PSM) analysis, patients were matched in a 1:1 ratio. Subgroup analysis was conducted according to the American Joint Committee on Cancer (AJCC) staging system.

Results

Before PSM, HCC patients with BDTT had more advanced tumor stages and adverse clinicopathological features. Recurrence-free survival (RFS) and overall survival (OS) were significantly higher in the non-BDTT group before PSM (RFS, p < 0.001; OS, p < 0.001), while after PSM, the BDTT group had significantly poorer RFS (p = 0.025). There was no difference in OS between the groups (p = 0.588). Subgroup analysis showed that RFS and OS in AJCC stage I–II patients were significantly poorer in the BDTT group; no differences were found in the AJCC stage III group before or after PSM. When the presence of BDTT was recommended to increase the AJCC staging system by one stage in AJCC stage I–II patients, the predictive ability for RFS and OS was higher.

Conclusions

BDTT was associated with significantly poorer long-term surgical outcomes in AJCC stage I–II patients. A modified AJCC staging system including BDTT status in stage I–II might have a better prognostic ability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Change history

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  Google Scholar 

  2. Kokudo T, Hasegawa K, Matsuyama Y, et al. Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. J Hepatol. 2016;65:938–43.

    Article  Google Scholar 

  3. Shah SA, Tan JC, McGilvray ID, et al. Does microvascular invasion affect outcomes after liver transplantation for HCC? A histopathological analysis of 155 consecutive explants. J Gastrointest Surg. 2007;11:464–71.

    Article  Google Scholar 

  4. Zeng H, Xu LB, Wen JM, et al. Hepatocellular carcinoma with bile duct tumor thrombus: a clinicopathological analysis of factors predictive of recurrence and outcome after surgery. Medicine (Baltimore). 2015;94:e364.

    Article  CAS  Google Scholar 

  5. Navadgi S, Chang CC, Bartlett A, et al. Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus. HPB (Oxford). 2016;18:312–6.

    Article  Google Scholar 

  6. Yeh TS, Wang F, Chen TC, et al. Expression profile of microRNA-200 family in hepatocellular carcinoma with bile duct tumor thrombus. Ann Surg. 2014;259:346–54.

    Article  Google Scholar 

  7. Meng KW, Dong M, Zhang WG, et al. Clinical characteristics and surgical prognosis of hepatocellular carcinoma with bile duct invasion. Gastroenterol Res Pract. 2014;2014:604971.

    Article  Google Scholar 

  8. Yu XH, Xu LB, Liu C, et al. Clinicopathological characteristics of 20 cases of hepatocellular carcinoma with bile duct tumor thrombi. Dig Dis Sci. 2011;56:252–9.

    Article  Google Scholar 

  9. Wang DD, Wu LQ, Wang ZS. Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection: a matched study. Hepatobiliary Pancreat Dis Int. 2016;15:626–32.

    Article  Google Scholar 

  10. Kim JM, Kwon CH, Joh JW, et al. Incidental microscopic bile duct tumor thrombi in hepatocellular carcinoma after curative hepatectomy: a matched study. Medicine (Baltimore). 2015;94:e450.

    Article  CAS  Google Scholar 

  11. Rammohan A, Sathyanesan J, Rajendran K, et al. Bile duct thrombi in hepatocellular carcinoma: is aggressive surgery worthwhile? HPB (Oxford). 2015;17:508–13.

    Article  Google Scholar 

  12. Ikenaga N, Chijiiwa K, Otani K, et al. Clinicopathologic characteristics of hepatocellular carcinoma with bile duct invasion. J Gastrointest Surg. 2009;13:492–7.

    Article  Google Scholar 

  13. Yeh CN, Jan YY, Lee WC, et al. Hepatic resection for hepatocellular carcinoma with obstructive jaundice due to biliary tumor thrombi. World J Surg. 2004;28:471–5.

    Article  Google Scholar 

  14. Noda T, Nagano H, Tomimaru Y, et al. Prognosis of hepatocellular carcinoma with biliary tumor thrombi after liver surgery. Surgery. 2011;149:371–7.

    Article  Google Scholar 

  15. Wong TC, Cheung TT, Chok KS, et al. Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus. HPB (Oxford). 2015;17:401–8.

    Article  Google Scholar 

  16. Shiomi M, Kamiya J, Nagino M, et al. Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management. Surgery. 2001;129:692–8.

    Article  CAS  Google Scholar 

  17. Satoh S, Ikai I, Honda G, et al. Clinicopathologic evaluation of hepatocellular carcinoma with bile duct thrombi. Surgery. 2000;128:779–83.

    Article  CAS  Google Scholar 

  18. Orimo T, Kamiyama T, Yokoo H, et al. Hepatectomy for hepatocellular carcinoma with bile duct tumor thrombus, including cases with obstructive jaundice. Ann Surg Oncol. 2016;23:2627–34.

    Article  Google Scholar 

  19. Liu PH, Hsu CY, Hsia CY, et al. Prognosis of hepatocellular carcinoma: assessment of eleven staging systems. J Hepatol. 2016;64:601–8.

    Article  CAS  Google Scholar 

  20. Tellapuri S, Sutphin PD, Beg MS, et al. Staging systems of hepatocellular carcinoma: a review. Indian J Gastroenterol. 2018;37:481–91.

    Article  Google Scholar 

  21. Chun YS, Pawlik TM, Vauthey JN. 8th Edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol. 2018;25:845–7.

    Article  Google Scholar 

  22. Kim DS, Kim BW, Hatano E, et al. Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korea–Japan multicenter study. Ann Surg. 2020;271:913–21.

    Article  Google Scholar 

  23. Clark W, Schulz MD. Hepatoma, with invasion of cystic duct and metastasis to third lumbar vertebra. N Engl J Med. 1947;237:673–6.

    Article  CAS  Google Scholar 

  24. Jang YR, Lee KW, Kim H, et al. Bile duct invasion can be an independent prognostic factor in early stage hepatocellular carcinoma. Korean J Hepatobiliary Pancreat Surg. 2015;19:167–72.

    Article  Google Scholar 

  25. Minagawa M, Ikai I, Matsuyama Y, et al. Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg. 2007;245:909–22.

    Article  Google Scholar 

  26. Ueno S, Tanabe G, Nuruki K, et al. Prognostic performance of the new classification of primary liver cancer of Japan (4th edition) for patients with hepatocellular carcinoma: a validation analysis. Hepatol Res. 2002;24:395–403.

    Article  Google Scholar 

  27. Lu WP, Tang HW, Yang ZY, et al. A proposed modification for the Barcelona Clinic Liver Cancer staging system: adding bile duct tumor thrombus status in patients with hepatocellular carcinoma. Am J Surg. 2020;220:965–71.

    Article  Google Scholar 

Download references

Acknowledgment

The authors wish to thank all the staff of the participating hospitals for their kind cooperation and support, as well as all patients for their participation.

Funding

This study was funded by the Startup Fund for scientific research, Fujian Medical University (2018QH1112) and the Natural Science Foundation of Fujian Province (2020J011105).

Author information

Author notes

  1. Jun-Yi Wu and Ju-Xian Sun contributed equally to this study.

Authors and Affiliations

  1. Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China

    Jun-Yi Wu MD, PhD, Jia-Yi Wu MD, Xiao-Xiao Huang MD, Yan-nan Bai MD & Mao-Lin Yan MD, PhD

  2. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Ju-Xian Sun MD & Shu-Qun Cheng MD, PhD

  3. Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China

    Yong-Gang Wei MD

  4. Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China

    Zhi-Bo Zhang MD

  5. Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China

    Jian-Yin Zhou MD

Authors
  1. Jun-Yi Wu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ju-Xian Sun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jia-Yi Wu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiao-Xiao Huang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yan-nan Bai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong-Gang Wei MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhi-Bo Zhang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jian-Yin Zhou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shu-Qun Cheng MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mao-Lin Yan MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

J-YW, J-XS, J-YW, X-XH, YB, Y-GW, Z-BZ, J-YZ, S-QC, and M-LY contributed to the surgery and the collection of data. J-YW, J-XS, and J-YW contributed to the analysis of data. S-QC and M-LY served as scientific advisors. J-YW, J-XS, S-QC, and M-LY interpreted the results, and wrote the article, and Y-GW, Z-BZ, J-YZ, S-QC, and M-LY made critical comments and revised the article. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Shu-Qun Cheng MD, PhD or Mao-Lin Yan MD, PhD.

Ethics declarations

Disclosure

Jun-Yi Wu, Ju-Xian Sun, Jia-Yi Wu, Xiao-Xiao Huang, Yan-nan Bai, Yong-Gang Wei, Zhi-Bo Zhang, Jian-Yin Zhou, Shu-Qun Cheng, and Mao-Lin Yan report no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Fig. 2 c and d was corrected.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, JY., Sun, JX., Wu, JY. et al. Impact of Bile Duct Tumor Thrombus on the Long-Term Surgical Outcomes of Hepatocellular Carcinoma Patients: A Propensity Score Matching Analysis. Ann Surg Oncol 29, 949–958 (2022). https://doi.org/10.1245/s10434-021-10799-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-10799-0

Search

Navigation