Gut Liver.  2014 Sep;8(5):526-535. 10.5009/gnl13370.

Effective Biliary Drainage and Proper Treatment Improve Outcomes of Hepatocellular Carcinoma with Obstructive Jaundice

• Suh YG
• Kim DY
• Han KH
• Seong J

• KMID: 2070063
• DOI: http://doi.org/10.5009/gnl13370

Abstract

BACKGROUND/AIMS
We investigated the treatment outcomes and prognostic factors of hepatocellular carcinoma (HCC) with obstructive jaundice.
METHODS
Among 2,861 patients newly diagnosed with HCC between 2002 and 2011, a total of 63 patients who initially presented with obstructive jaundice were analyzed. Only four patients presented with resectable tumors and underwent curative resection. In the other patients who presented with unresectable tumors, 5, 8, 9, and 18 patients received transarterial chemoembolization (TACE), chemotherapy, radiotherapy, and combined treatment, respectively. Both the clinical and the treatment factors that affect overall survival (OS) were analyzed.
RESULTS
The median OS was 4 months, and the 1-year OS rate was 23%. Patients who received treatment for HCC had a significantly improved OS rate compared with the patients who received supportive care only (1-year OS, 32% vs 0%; p<0.01). Responders to treatment showed a better OS than nonresponders (1-year OS, 52% vs 0%; p<0.01). TACE and radiotherapy resulted in relatively good treatment responses of 64% and 67%, respectively. In multivariate analyses, treatment of HCC (p=0.02) and the normalization of serum bilirubin by biliary drainage (p=0.02) were significantly favorable prognostic factors that affected the OS.
CONCLUSIONS
Unresectable HCC with obstructive jaundice has a poor prognosis. However, effective biliary drainage and treatment of HCC such as with TACE or radiotherapy improves survival.

Keyword

Transarterial chemoembolization; Drug therapy; Radiotherapy

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/*complications/mortality/*therapy
Chemoembolization, Therapeutic
Combined Modality Therapy
Drainage
Female
Humans
Jaundice, Obstructive/complications/mortality/*therapy
Liver Neoplasms/*complications/mortality/*therapy
Male
Middle Aged
Prognosis
Retrospective Studies
Treatment Outcome