Prognosis of hepatocellular carcinoma with biliary tumor thrombi after liver surgery.

BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.