title: Usefulness of resection for hepatocellular carcinoma with macroscopic bile duct tumor thrombus.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan baoatu@hotmail.com.
authors: Atsushi
authors: A
authors: Oba
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors: Shinichiro
authors: S
authors: Takahashi
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors: Yuichiro
authors: Y
authors: Kato
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors: Naoto
authors: N
authors: Gotohda
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors: Takahiro
authors: T
authors: Kinoshita
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors: Hidehito
authors: H
authors: Shibasaki
authors: Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors: Masafumi
authors: M
authors: Ikeda
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors: Masaru
authors: M
authors: Konishi
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013927:Thrombosis / Q000473:pathology*
keywords: Bile duct tumor thrombus; hepatocellular carcinoma; prognostic significance; resection