Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Eur Radiol. 2018 Apr;28(4):1540-1550. doi: 10.1007/s00330-017-5110-7. Epub 2017 Nov 9.
To determine the necessity of preprocedural biliary drainage prior to chemoembolisation for hepatocellular carcinoma (HCC) with bile duct invasion.
The study included 52 patients who received chemoembolisation for unresectable HCC invading bile duct and causing hyperbilirubinemia (>3 mg/dL). Patients were divided into three groups according to biliary drainage and its effect: effective drainage (n=21), ineffective drainage (n=17), and non-drainage (n=14). Thirty-day mortality, length of hospitalisation, adverse events recorded using Common Terminology Criteria for Adverse Events (CTCAE), survival, and tumour response was compared among three groups.
Thirty-day mortality rates were 14.3% (n=3), 17.6% (n=3), and 7.1% (n=1) for effective, ineffective, and non-drainage groups, respectively, and did not differ significantly among groups (p=0.780). The mean length of hospitalisation was shorter in non-drainage group compared to ineffective drainage group (12.1±11.4 vs 34.1±29.6 days, p=0.012). Mean differences in CTCAE grade for laboratory parameters before and after chemoembolisation were not significantly different among three groups. Survival among three groups was not significantly different (p=0.239-0.825). The tumour response was also not significantly different among three groups (p=0.679).
Biliary drainage may not be mandatory prior to chemoembolisation in patients with HCC invading the bile duct.
• Chemoembolisation without biliary drainage can be performed for icteric HCC. • Chemoembolisation without biliary drainage is not accompanied by increased adverse events. • Preprocedural biliary drainage may not be mandatory for chemoembolisation for icteric HCC.
确定经导管肝动脉化疗栓塞术（TACE）治疗伴有胆管侵犯的肝细胞癌（HCC）患者是否需要在术前进行胆道引流。
本研究纳入了 52 例因胆管侵犯导致高胆红素血症（>3mg/dL）而无法手术切除的 HCC 患者，这些患者接受了 TACE 治疗。根据胆道引流及其效果将患者分为三组：有效引流组（n=21）、无效引流组（n=17）和未引流组（n=14）。比较三组之间的 30 天死亡率、住院时间、使用不良事件通用术语标准（CTCAE）记录的不良事件、生存率和肿瘤反应。
有效引流组、无效引流组和未引流组的 30 天死亡率分别为 14.3%（n=3）、17.6%（n=3）和 7.1%（n=1），三组之间无显著差异（p=0.780）。与无效引流组相比，未引流组的住院时间更短（12.1±11.4 与 34.1±29.6 天，p=0.012）。三组之间 CTCAE 分级前后实验室参数的平均差异无统计学意义。三组之间的生存情况无显著差异（p=0.239-0.825）。三组之间的肿瘤反应也无显著差异（p=0.679）。
对于胆管侵犯的 HCC 患者，TACE 前不一定需要胆道引流。
• 对于黄疸型 HCC，可以进行无胆道引流的 TACE。• 无胆道引流的 TACE 不会增加不良事件。• 对于黄疸型 HCC，TACE 前不一定需要进行胆道引流。
