title: Hepatocellular carcinoma with bile duct tumor thrombus: surgical outcomes and the prognostic impact of concomitant major vascular invasion.
abstract: BACKGROUND
  The aim of this study was to clarify the long-term surgical outcomes of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) and to identify a therapeutic strategy for this condition.
  
  
  METHODS
  Forty-four patients who underwent hepatectomy for HCC with BDTT or direct invasion involving the first branches of the bile duct or common hepatic duct were enrolled in this study. The overall survival time and time to recurrence were analyzed.
  
  
  RESULTS
  The median survival time and the 5-year survival rate were 23.7 months and 31.0%, respectively. Child-Pugh classification B [hazard ratio (HR) 4.92; 95% confidence interval (CI) 1.97-11.65], major vascular invasion (MVI; HR 2.79; 95% CI 1.14-6.87), and serosal invasion (HR 2.71; 95% CI 1.19-6.02) were independent prognostic factors for overall survival. The median survival times were 12.3 and 72.3 months for the patients with and without MVI, respectively. Among the 41 patients who underwent macroscopic curative resection, the median time to recurrence and the 5-year recurrence rate were 8.6 months and 85.6%, respectively. MVI was the only independent prognostic factor for recurrence (HR 3.31; 95% CI 1.55-7.05). The median times to recurrence were 3.7 and 11.6 months for the patients with and without MVI, respectively.
  
  
  CONCLUSIONS
  Concomitant MVI was a strong prognostic factor in the setting of HCC with BDTT. Extended hepatectomy provided a good prognosis for the patients with BDTT alone without MVI.
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho Shogoin, Sakyo-ku, Kyoto, 6068507, Japan, yokasai@kuhp.kyoto-u.ac.jp.
authors: Yosuke
authors: Y
authors: Kasai
authors: Etsuro
authors: E
authors: Hatano
authors: Satoru
authors: S
authors: Seo
authors: Kojiro
authors: K
authors: Taura
authors: Kentaro
authors: K
authors: Yasuchika
authors: Shinji
authors: S
authors: Uemoto
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D002648:Child; D002779:Cholestasis / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006500:Hepatic Duct, Common; D006503:Hepatic Veins; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011169:Portal Vein; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors
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