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Treatment, biliary drainage improved survival in HCC, obstructive jaundice

Chemotherapy, transarterial chemoembolization and successful biliary drainage were effective in improving overall survival among patients with unresectable hepatocellular carcinoma with obstructive jaundice, researchers from Korea found.

“Proper management for HCC with obstructive jaundice remains unclear, especially in patients with unresectable HCC,” the researchers wrote. “We analyzed the treatment outcomes in patients with HCC accompanying obstructive jaundice due to bile duct tumor invasion treated by surgery, transarterial chemoembolization (TACE), radiotherapy, chemotherapy or a combination of these treatments.”

Sixty-three patients of 2,861 with newly diagnosed HCC had reported jaundice as a result of bile duct tumor invasion and were included in final analysis. Most patients were male (81%; median age, 54 years). Four of the 63 patients had resectable tumors and underwent curative resection. Of the patients with unresectable tumors, five were treated with TACE, eight patients with chemotherapy, nine patients with radiotherapy and 18 patients received a combination of therapy.

Patients who received any sort of treatment for HCC had an improved 1-year overall survival rate compared with patients who were untreated (32% vs. 0%; P<.01). TACE generated 64% favorable responses from patients, and radiotherapy generated 67%. Biliary drainage were successful in nine patients who underwent percutaneous transhepatic biliary drainage and six who underwent endoscopic retrograde cholangiopancreatography stenting; biliary drainage improved 1-year survival rates (24% vs. 0%; P=.02).  

Multivariate analysis indicated that the treatment of HCC and effective biliary drainage were prognostic factors for improved overall survival (P=.02 for both). The patients who were not successful in biliary drainage had higher frequencies of “common hepatic duct obstruction and multiple tumors” compared with patients who underwent successful drainage.   

Overall, the median overall survival was 4 month and the 1-year overall survival rate was 23% among all patients.

“Although the prognosis of HCC patients with obstructive jaundice is dismal, our data suggest that effective biliary drainage and treatment of HCC, including surgery, TACE and radiotherapy, can improve survival,” the researchers concluded. “Techniques to improve biliary drainage and preserve liver function from jaundice-associated toxicities are required to improve the prognosis of HCC patients with obstructive jaundice due to bile duct tumor invasion.”

Disclosure: The researchers report no relevant financial disclosures.