Effective Biliary Drainage and Proper Treatment Improve Outcomes of Hepatocellular Carcinoma with Obstructive Jaundice
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Background/Aims: We investigated the treatment outcomesand prognostic factors of hepatocellular carcinoma(HCC) with obstructive jaundice. Methods: Among 2,861 patientsnewly diagnosed with HCC between 2002 and 2011,a total of 63 patients who initially presented with obstructivejaundice were analyzed. Only four patients presented withresectable tumors and underwent curative resection. In theother patients who presented with unresectable tumors, 5,8, 9, and 18 patients received transarterial chemoembolization(TACE), chemotherapy, radiotherapy, and combinedtreatment, respectively. Both the clinical and the treatmentfactors that affect overall survival (OS) were analyzed. Results:The median OS was 4 months, and the 1-year OS ratewas 23%. Patients who received treatment for HCC had asignificantly improved OS rate compared with the patientswho received supportive care only (1-year OS, 32% vs 0%;p<0.01). Responders to treatment showed a better OS thannonresponders (1-year OS, 52% vs 0%; p<0.01). TACE andradiotherapy resulted in relatively good treatment responsesof 64% and 67%, respectively. In multivariate analyses,treatment of HCC (p=0.02) and the normalization of serumbilirubin by biliary drainage (p=0.02) were significantly favorableprognostic factors that affected the OS. Conclusions:Unresectable HCC with obstructive jaundice has a poor prognosis. However, effective biliary drainage and treatment ofHCC such as with TACE or radiotherapy improves survival
Abstract
Background/Aims: We investigated the treatment outcomesand prognostic factors of hepatocellular carcinoma(HCC) with obstructive jaundice. Methods: Among 2,861 patientsnewly diagnosed with HCC between 2002 and 2011,a total of 63 patients who initially presented with obstructivejaundice were analyzed. Only four patients presented withresectable tumors and underwent curative resection. In theother patients who presented with unresectable tumors, 5,8, 9, and 18 patients received transarterial chemoembolization(TACE), chemotherapy, radiotherapy, and combinedtreatment, respectively. Both the clinical and the treatmentfactors that affect overall survival (OS) were analyzed. Results:The median OS was 4 months, and the 1-year OS ratewas 23%. Patients who received treatment for HCC had asignificantly improved OS rate compared with the patientswho received supportive care only (1-year OS, 32% vs 0%;p<0.01). Responders to treatment showed a better OS thannonresponders (1-year OS, 52% vs 0%; p<0.01). TACE andradiotherapy resulted in relatively good treatment responsesof 64% and 67%, respectively. In multivariate analyses,treatment of HCC (p=0.02) and the normalization of serumbilirubin by biliary drainage (p=0.02) were significantly favorableprognostic factors that affected the OS. Conclusions:Unresectable HCC with obstructive jaundice has a poor prognosis. However, effective biliary drainage and treatment ofHCC such as with TACE or radiotherapy improves survival
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