Juxian Sun1, Jiayi Wu2,3, Chang Liu1, Jie Shi1, Yonggang Wei4, Jianyin Zhou5, Zhibo Zhang6, Wan Yee Lau1,7, Maolin Yan2,3, Shuqun Cheng1. 1. Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200433, China. 2. Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, China. 3. Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fuzhou 350001, China. 4. Department of Hepatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. 5. Department of Hepatobiliary Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361004, China. 6. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350002, China. 7. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China.
Abstract
OBJECTIVE: To establish a new classification of biliary tumor thrombus (BTT). METHODS: Overall survival of patients with BTT was first used to determine whether it correlated with current hepatocellular carcinoma staging systems. Univariate and multivariate analyses were used to determine factors affecting the overall survival (OS) to form the basis of our new classification for BTT. RESULTS: All 6 international staging systems showed overlapping survival curves. Univariate followed by multivariate analyses showed that total bilirubin and intrahepatic/extrahepatic BTT were significant risk factors of OS. Based on these data, a new BTT classification was defined as: Type I: intrahepatic BTT; and Type II: extrahepatic BTT involving a common bile duct or common hepatic duct. Type I was further subdivided into type Ia: BTT involving a second-order intrahepatic duct or above, and type Ib: BTT involving a first-order intrahepatic duct. Type II was further subdivided into type IIa and type IIb using a cut-off total bilirubin (TB) > 300 μmol/L. The numbers (percentages) of patients with types I and II BTT were 69 (34.2%) and 133 (65.8%), respectively. The median OS of type I patients was significantly higher than that of type II patients (37.5 months vs. 23.2 months; P = 0.002). Using subgroup analyses, OS outcomes were significantly different between the subgroups of type IIb and type IIa, although there was no significant difference between the type Ia and type Ib subgroups (P = 0.07). CONCLUSIONS: A new BTT classification was established to predict prognoses of HCC patients with BTT who underwent liver resection.
OBJECTIVE: To establish a new classification of biliary tumor thrombus (BTT). METHODS: Overall survival of patients with BTT was first used to determine whether it correlated with current hepatocellular carcinoma staging systems. Univariate and multivariate analyses were used to determine factors affecting the overall survival (OS) to form the basis of our new classification for BTT. RESULTS: All 6 international staging systems showed overlapping survival curves. Univariate followed by multivariate analyses showed that total bilirubin and intrahepatic/extrahepatic BTT were significant risk factors of OS. Based on these data, a new BTT classification was defined as: Type I: intrahepatic BTT; and Type II: extrahepatic BTT involving a common bile duct or common hepatic duct. Type I was further subdivided into type Ia: BTT involving a second-order intrahepatic duct or above, and type Ib: BTT involving a first-order intrahepatic duct. Type II was further subdivided into type IIa and type IIb using a cut-off total bilirubin (TB) > 300 μmol/L. The numbers (percentages) of patients with types I and II BTT were 69 (34.2%) and 133 (65.8%), respectively. The median OS of type I patients was significantly higher than that of type II patients (37.5 months vs. 23.2 months; P = 0.002). Using subgroup analyses, OS outcomes were significantly different between the subgroups of type IIb and type IIa, although there was no significant difference between the type Ia and type Ib subgroups (P = 0.07). CONCLUSIONS: A new BTT classification was established to predict prognoses of HCC patients with BTT who underwent liver resection.