Feng Jin-Kai, Wu Yu-Xuan, Chen Zhen-Hua, Sun Ju-Xian, Wang Kang, Chai Zong-Tao, Shi Jie, Guo Wei-Xing, Cheng Shu-Qun
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
College of Basic Medical Sciences, Second Military Medical University, Shanghai, China.
Ann Transl Med. 2020 Dec;8(24):1683. doi: 10.21037/atm-20-4698.
The effect of bile duct tumor thrombus (BDTT) on the postoperative long-term prognosis of hepatocellular carcinoma (HCC) patients is still under debate.
The PubMed, Embase, Cochrane Library, Web of Science databases were systematically searched to collect the clinicopathologic characteristics, perioperative indices, and postoperative survival outcomes in the BDTT and non-BDTT groups of HCC patients from inception to February 1, 2020. The study outcomes were extracted by two independent investigators.
A total of 15 studies involving 6,484 patients were included. The meta-analysis revealed that the levels of serum total bilirubin and alkaline phosphatase were notably higher in patients with HCC and BDTT than those without BDTT. Meanwhile, HCC patients with BDTT had more aggressive biological characteristics, such as poor tumor differentiation, macrovascular invasion, and lymph node metastasis, as compared to patients without BDTT. The 1-year [odds ratio (OR) 0.39, 95% confidence interval (CI): 0.31-0.48, P<0.01], 3-year (OR 0.33, 95% CI: 0.22-0.51, P<0.01) and 5-year overall survival (OS) rates (OR 0.31, 95% CI: 0.20-0.49, P<0.01) of the BDTT group were significantly worse than those of the non-BDTT group. The hazard ratio of HCC with BDTT was 4.27 (95% CI: 3.47-5.26, P<0.01) within 5 years after hepatectomy.
HCC patients with BDTT had worse OS compared to patients free of BDTT after surgery. BDTT may be a potential prognostic factor for HCC patients.
胆管肿瘤血栓（BDTT）对肝细胞癌（HCC）患者术后长期预后的影响仍存在争议。
系统检索PubMed、Embase、Cochrane图书馆、Web of Science数据库，收集自开始至2020年2月1日HCC患者BDTT组和非BDTT组的临床病理特征、围手术期指标及术后生存结局。研究结局由两名独立研究者提取。
共纳入15项研究，涉及6484例患者。荟萃分析显示，HCC合并BDTT患者的血清总胆红素和碱性磷酸酶水平显著高于无BDTT患者。同时，与无BDTT患者相比，HCC合并BDTT患者具有更具侵袭性的生物学特征，如肿瘤分化差、大血管侵犯和淋巴结转移。BDTT组的1年[比值比（OR）0.39，95%置信区间（CI）：0.31 - 0.48，P<0.01]、3年（OR 0.33，95% CI：0.22 - 0.51，P<0.01）和5年总生存（OS）率（OR 0.31，95% CI：0.20 - 0.49，P<0.01）显著低于非BDTT组。肝切除术后5年内，HCC合并BDTT的风险比为4.27（95% CI：3.47 - 5.26，P<0.01）。
与术后无BDTT的患者相比，HCC合并BDTT的患者OS更差。BDTT可能是HCC患者的一个潜在预后因素。
