Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Surgery. 2011 Mar;149(3):371-7. doi: 10.1016/j.surg.2010.08.006.
The incidence of biliary tumor thrombi (BTT) in hepatocellular carcinoma (HCC) is very low and operative outcomes are poor. There is little information on the postoperative prognostic factors for patients with HCC with BTT. We analyzed retrospectively the clinicopathologic features of 22 patients with HCC with BTT to identify the prognostic factors associated with operative outcome.
Of the 551 patients who underwent hepatic resection for HCC between 1988 and 2007, 22 (4.0%) had HCC with BTT. Their clinicopathologic features were compared with those with HCC but no BTT. The survival rates were also calculated for various clinicopathologic factors.
Of the 22 patients, 13 (59%) also had portal or hepatic vein tumor thrombosis. Multiple HCC tumors were identified in 91% of patients and 20 patients were classified as stage IVA. The 1- and 3-year overall survival rates were 89% and 73% for patients with HCC free of BTT, respectively, and 62% and 30%, respectively, for those of HCC with BTT (P < .0001). Portal or hepatic vein tumor thrombosis was the only significant determinant of poor prognosis in 22 patients with HCC with BTT. The 1- and 3-year cumulative survival rates were 89% and 52%, respectively, for patients with only BTT but worse in those of HCC with both BTT and portal or hepatic vein tumor thrombosis (43% and 17%, respectively).
The clinicopathologic features of HCC patients with BTT indicated advanced-stage disease and poor operative outcomes. Portal or hepatic vein tumor thrombosis was the only significant determinant of poor prognosis of HCC patients with BTT.
肝细胞癌（HCC）合并胆内肿瘤血栓（BTT）的发病率非常低，手术结果较差。关于合并 BTT 的 HCC 患者术后预后因素的信息很少。我们回顾性分析了 22 例 HCC 合并 BTT 患者的临床病理特征，以确定与手术结果相关的预后因素。
在 1988 年至 2007 年间接受肝切除术治疗 HCC 的 551 例患者中，有 22 例（4.0%）合并 HCC 和 BTT。将其临床病理特征与无 BTT 的 HCC 患者进行比较。还计算了各种临床病理因素的生存率。
22 例患者中，13 例（59%）还合并门静脉或肝静脉肿瘤血栓。91%的患者有多个 HCC 肿瘤，20 例患者被归类为 IVA 期。无 BTT 的 HCC 患者的 1 年和 3 年总生存率分别为 89%和 73%，而有 BTT 的 HCC 患者分别为 62%和 30%（P<.0001）。门静脉或肝静脉肿瘤血栓是合并 HCC 且有 BTT 的 22 例患者预后不良的唯一显著决定因素。仅 BTT 的患者 1 年和 3 年累积生存率分别为 89%和 52%，而同时存在 BTT 和门静脉或肝静脉肿瘤血栓的 HCC 患者则分别为 43%和 17%。
HCC 合并 BTT 患者的临床病理特征表明疾病处于晚期，手术结果较差。门静脉或肝静脉肿瘤血栓是合并 HCC 且有 BTT 的患者预后不良的唯一显著决定因素。
