Prognosis Of Primary Liver Cancer With Bile Duct Tumor Thrombus After Surgical Treatment

Background: Primary liver cancer(PLC)with bile duct tumor thrombus(BDTT)is low incidence and rarely seen in clinical practice,but its treatment strategies and prognosis are still a subject worthy of debate.The present study was aimed to analyze prognosis of primary liver cancer with bile duct tumor thrombus after surgical treatment.In particular,the effects of different surgical methods on long-term survival were studied to identify optimal surgical methods and the risk factors for long-term survival in patients with PLC accompanied by BDTT.Methods: From January 2011 to December 2019,24 patients with primary liver cancer accompanied by bile duct tumor thrombus were underwent surgical treatment in Hepatobiliary Department,Zhongshan Hospital,Xiamen University,to retrospectively analyze these patients clinical features and pathological specimens,and to compare the effects of different surgical measures on overall survival(OS)and disease-free survival(DFS).Cox regression models were used to determine independent risk factors of postoperative survival and tumor recurrence.Results: All 24 patients underwent surgical treatment.The 1-,3-,and 5-year overall survival rates for all patients were 83.1%,66.3%,44.8% respectively.The 1-,3-,and5-year overall survival rates were 92.9%,83.6% and 57.3% for patients in the hemihepatectomy with removal of biliary tumor thrombi group,and 83.3%,62.5% and41.7% for patients in the local hepatectomy with removal of biliary tumor thrombi group respectively,and the 1-year overall survival rates of patients treated by thrombectomy through a choledochotomy was 33.3%(P=0.006).In addition,both Cox univariate and multivariate analysis indicated that surgical methods and non-R0 resection were independent risk factors for disease-free survival and overall survival of24 patients with PLC accompanied by BDTT.The average overall survival time of patients with PLC accompanied by BDTT who received R0 resection was longer than that of patients who without receive R0 resection(76.2 vs 24.9 months,P=0.002).The1-,3-,and 5-year overall survival rates were 94.1%,77.6%,67.9% for patients who received R0 resection,and 57.1%,38.1% and 0% for patients who without receive R0 resection respectively(P=0.002).Conclusion: Bile duct tumor thrombus is considered a risk factor of poor prognosis for patients with primary liver cancer.However,through timely diagnosis and active selection of appropriate surgical procedures to achieve R0 resection could still improve the prognosis of patients and obtain long-term survival,even achieve radical therapeutic effects.