The Clinical Classifications And Prognosis Analysis Of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus

Objective:To investigate the characteristics of clinical pathological of the hepatocellular carcinoma?HCC?with bile duct tumor thrombi?BDTT?and effective prognostic factors,increasing awareness of this disease and evaluating prognosis situation of those HCC patients with BDTT after hepatectomy.Methods:This study reviewed 182 patients whom were diagnosed as hepatocellular carcinoma and accepted hepatectomy in the department of hepatobiliary surgery of Fujian provincial hospital from January 1^st,2009 to December 31^st,2014.,including 155 patients who were confirmed as HCC without BDTT and 27 patients HCC with BDTT;56 of all patients were accompanying Major vascular invasion?MVI?and 96 patients absenting MVI.There are 27 patients in BDTT group,including 18 patients with MVI and 9 patients without MVI.According to the criterion of classification of Satoh^[1],8patients were classified into type ?,15 patients were type ? and 4 patients were type ?.In this study,the software of SPSS 24.0 was used to analyze the clinical pathological data of between the HCC patients with BDTT and without BDTT and the relative data of BDTT group.The Univariate survival analysis,multivariate survival analysis were used to explore the factors influencing the prognosis of HCC patients with BDTT.Results:The result showed that an total overall survival rate of the HCC patients without BDTT were 86%at 1-year,62%at 3-years,49%at 5-years compared respectively 81,31,18%for the HCC patients with BDTT.The median survival times?MST?were 58.61 for the HCC patients without BDTT and 24.13 mouths for the HCC patients with BDTT?P=0.011?.The HCC patients without BDTT showed that the total overall recurrence rate of 34%at 1-year,54%at 3-years,73%at 5-years compared respectively 48,93,93%for the HCC patients with BDTT.The median recurrence times were 30.0 for the HCC patients without BDTT and 12.75 mouths for the HCC patients with BDTT?P=0.023?.Therefore,when the study was limited to MVI with 1:1propensity matching,the total survival rate of 1-year,3-years,5-years of two groups were 70%,44%,30%and 81%,31%,18%,,respectively;the median survival time was 31.5 months and 24.1 months?P=0.540?.The HCC patients without BDTT showed that the totsl overall recurrence rate of 56%at 1-year,78%at 3-years,81%at 5-years compared respectively 48,93,93%for the HCC patients with BDTT.The median recurrence times were 10.8 mouths for the HCC patients without BDTT and 12.75mouths for the HCC patients with BDTT?P=0.771?.Univariate survival analysis showed that TNM stage of tumor,MVI and the degree of pathological differentiation were the prognostic risk factors for the HCC patients with BDTT.The COX regression survival analysis showed that the degree of histological differentiation,MVI were the poor prognosis independent risk factors?P<0.05?for the HCC patients with BDTT.BDTT was classified into 3 types?type ?,type ?,type ??according to the criterion of classification of Satoh,the results suggested that 1-years,3-years,5-years of survival rate of the three types were was 68%,38%,13%and 80%,27%,19%and 100%,25%,25%respectively,the median survival time were 24,21 and 30 mouths?P=0.70?,respectively.1-years,3-years,5-years of recurrence rate of the three types were was50%,87%,87%and 60%,100%,100%and 25%,75%,75%respectively,the median survival time were 12,10 and 18 mouths?P=0.88?,respectively.The clinical classification of BDTT does not affect the prognosis of the disease,but the result suggests that there was a significant difference between comparing type ? with type ? and comparing type ? with type ? in choosing the bile duct operations by contrasting the clinic date of the 3 classifications of BDTT?P=0.001.P=0.024?.It is suggested that different clinical types of the BDTT may be related to the surgical choice of bile duct.Conclusions:Concomitant MVI and poorly differentiated in Histology were strong independently prognostic factors in the setting of HCC with BDTT.R0resection provided a good prognosis for the patients with BDTT alone without MVI;It is not recommended for all patients with BDTT accepted BDR combined Roux-en-Y;The different clinical classification of BDTT did not differ significantly between the HCC patients with BDTT and those without BDTT,but it could provide some reference for the choice of surgical methods for these.