Hepatocellular carcinoma with tumor thrombus in bile duct: A proposal of new classification according to resectability of primary lesion

Table 1 Basic clinical data of the patients of hepatocellular carcinoma with tumor thrombus in bile duct

No.	Sex	Age	Jaundice before treatment for BDTT		AFP, ng/mL	BDTT with first occurring/recurrent HCC or metastasis	BDTT with PVTT	History of hepatectomy before BDTT diagnosed	Time interval from hepatectomy to diagnosis of BDTT	Location of BDTT	Classification		Treatment for BDTT	Survival state during follow-up
			T-bil, μmol/L	D-bil, μmol/L							Satoh	Ours
1	M	58	16.0	0.0	9420.00	fo-HCC	Yes	/	/	IBD	N/A4	I	Resected with HCC	Dead
2	M	68	53.1	34.4	97.23	rHCC	No	Yes	6 yr	CBD	3	III	Extraction	Dead
3	M	70	16.7	6.2	737.00	rHCC/LgMT/ACMT	Yes	Yes	19 mo19 mo2	IBD	N/A5	IV	Lenvatinib+Sintilizumab	Alive with tumor
4	M	65	145.5	76.7	176.54	fo-HCC	No	/	/	LHD/RHD/CHD	2	IIa	Extrahepatic bile duct resection3	Dead
5	M	75	146.9	51.90	1.37	No	No	/	/	CBD	3	III	Extraction	Alive with tumor
6	M	68	224.1	183.8	1.84	rHCC/LNMT/ACMT	No	Yes	2 mo	CBD	3	III	Extraction	Dead
7	F	58	37.2	27.6	45.22	fo-HCC	No	/	/	CBD	3	IIb	Extraction	DFS

¹The patient received his first hepatectomy for HCC.

²The patient received his second operation for removal of the recurrent isolated HCC lesion in abdominal cavity.

³The patient received right hepatectomy accompanied with extrahepatic bile duct resection.

⁴BDTT diagnosed under microscope.

⁵BDTT located in the left intrahepatic bile ducts. ACMT: Abdominal cavity metastasis; AFP: Alpha-fetoprotein; BDTT: Bile duct tumor thrombi; CBD: Common bile duct; CHD: Common hepatic duct; D-bil: Direct bilirubin; DFS: Disease free survival; fo-HCC: First occurring hepatocellular carcinoma; IBD: Intrahepatic bile duct; LgMT: Lung metastasis; LHD: Left hepatic duct; LNMT: Lymph node metastasis; PVTT: Portal vein tumor thrombus; rHCC: Recurrent hepatocellular carcinoma; RHD: Right hepatic duct; T-bil: Total bilirubin.