Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Gut Liver. 2024 Sep 15;18(5):877-887. doi: 10.5009/gnl240032. Epub 2024 Jul 18.
BACKGROUND/AIMS: Bile duct invasion (BDI) is rarely observed in patients with advanced hepatocellular carcinoma (HCC), leading to hyperbilirubinemia. However, the efficacy of pretreatment biliary drainage for HCC patients with BDI and obstructive jaundice is currently unclear. Thus, the aim of this study was to assess the effect of biliary drainage on the prognosis of these patients.
We retrospectively enrolled a total of 200 HCC patients with BDI from multicenter cohorts. Patients without obstructive jaundice (n=99) and those who did not undergo HCC treatment (n=37) were excluded from further analysis. Finally, 64 patients with obstructive jaundice (43 subjected to drainage and 21 not subjected to drainage) were included. Propensity score matching was then conducted.
The biliary drainage group showed longer overall survival (median 10.13 months vs 4.43 months, p=0.004) and progression-free survival durations (median 7.00 months vs 1.97 months, p<0.001) than the non-drainage group. Multivariate analysis showed that biliary drainage was a significantly favorable prognostic factor for overall survival (hazard ratio, 0.42; p=0.006) and progression-free survival (hazard ratio, 0.30; p<0.001). Furthermore, in the evaluation of first response after HCC treatment, biliary drainage was beneficial (p=0.005). Remarkably, the durations of overall survival (p=0.032) and progression-free survival (p=0.004) were similar after propensity score matching.
Biliary drainage is an independent favorable prognostic factor for HCC patients with BDI and obstructive jaundice. Therefore, biliary drainage should be contemplated in the treatment of advanced HCC with BDI to improve survival outcomes.
背景/目的：胆管侵犯（BDI）在晚期肝细胞癌（HCC）患者中很少见，导致高胆红素血症。然而，对于伴有 BDI 和梗阻性黄疸的 HCC 患者，术前胆道引流的疗效尚不清楚。因此，本研究旨在评估胆道引流对这些患者预后的影响。
我们回顾性纳入了来自多中心队列的 200 例 HCC 伴 BDI 患者。无梗阻性黄疸的患者（n=99）和未接受 HCC 治疗的患者（n=37）被排除在进一步分析之外。最终，纳入了 64 例梗阻性黄疸患者（43 例行引流，21 例未行引流）。然后进行倾向评分匹配。
与未引流组相比，引流组的总生存期（中位 10.13 个月比 4.43 个月，p=0.004）和无进展生存期（中位 7.00 个月比 1.97 个月，p<0.001）均更长。多因素分析显示，胆道引流是总生存期（风险比，0.42；p=0.006）和无进展生存期（风险比，0.30；p<0.001）的显著有利预后因素。此外，在 HCC 治疗后首次反应的评估中，胆道引流有益（p=0.005）。值得注意的是，在倾向评分匹配后，总生存期（p=0.032）和无进展生存期（p=0.004）的持续时间相似。
胆道引流是伴有 BDI 和梗阻性黄疸的 HCC 患者的独立有利预后因素。因此，对于伴有 BDI 的晚期 HCC，应考虑胆道引流以改善生存结局。
