Yeh Chun-Nan, Jan Yi-Yin, Lee Wei-Chen, Chen Miin-Fu
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
World J Surg. 2004 May;28(5):471-5. doi: 10.1007/s00268-004-7185-y. Epub 2004 Apr 19.
Hepatocellular carcinoma (HCC) with obstructive jaundice due to biliary tumor thrombi is uncommon, and few studies have examined the outcome of hepatectomy for HCC with this unusual entity. This study examined the clinicopathologic factors influencing the outcomes of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi undergoing hepatectomy. The clinical features of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi (group A) undergoing hepatectomy from 1986 to 1998 were reviewed. The clinical features and factors influencing the outcome of 555 HCC patients without biliary tumor thrombi (group B) undergoing hepatectomy were used for comparison. Of 572 patients with surgically resected HCCs, 17 (3.0%) were classified into group A. Right upper quadrant pain, physical signs of jaundice, low albumin level, elevated bilirubin level, small tumor size, more vascular invasion, and tumor rupture were characteristic of group A patients. Multivariate stepwise logistic regression analysis revealed no independently significant factor differentiating group A patients from group B patients. The disease-free survival was similar between the group A and B patients, although group B patients exhibited significantly better overall survival (p = 0.014). Vascular invasion may adversely influence overall survival in group A patients undergoing hepatic resection (p = 0.0709). When feasible, hepatic resection is the preferred treatment for HCC patients with obstructive jaundice due to biliary tumor thrombi. It can achieve a disease-free survival comparable to that of HCC patients without biliary tumor thrombi. However, HCC patients with biliary tumor thrombi had significantly worse overall survival than did those without biliary tumor thrombi, especially those with concomitant vascular invasion.
因胆管肿瘤血栓导致梗阻性黄疸的肝细胞癌（HCC）并不常见，很少有研究探讨针对这一特殊情况的HCC肝切除术的预后。本研究调查了影响17例因胆管肿瘤血栓导致梗阻性黄疸而行肝切除术的HCC患者预后的临床病理因素。回顾了1986年至1998年间17例因胆管肿瘤血栓导致梗阻性黄疸而行肝切除术的HCC患者（A组）的临床特征。将其与555例无胆管肿瘤血栓而行肝切除术的HCC患者（B组）的临床特征及影响预后的因素进行比较。在572例接受手术切除的HCC患者中，17例（3.0%）被归入A组。右上腹疼痛、黄疸体征、低白蛋白水平、胆红素水平升高、肿瘤体积小、更多的血管侵犯和肿瘤破裂是A组患者的特征。多因素逐步逻辑回归分析显示，没有独立的显著因素能将A组患者与B组患者区分开来。A组和B组患者的无病生存期相似，尽管B组患者的总生存期明显更好（p = 0.014）。血管侵犯可能对接受肝切除术的A组患者的总生存期产生不利影响（p = 0.0709）。在可行的情况下，肝切除术是因胆管肿瘤血栓导致梗阻性黄疸的HCC患者的首选治疗方法。它能实现与无胆管肿瘤血栓的HCC患者相当的无病生存期。然而，有胆管肿瘤血栓的HCC患者的总生存期明显比没有胆管肿瘤血栓的患者差，尤其是那些伴有血管侵犯的患者。
