Appropriate treatment strategies improve survival of hepatocellular carcinoma patients with portal vein tumor thrombus

Ye, Jiazhou; Zhang, Yongquan; Ye, Haihong; Bai, Tao; Ma, Liang; Xiang, Bang‐De; Li, Le‐Qun

doi:10.3748/wjg.v20.i45.17141

Cited by 47 publications

(68 citation statements)

References 24 publications

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“…Only a few studies have classified PVTT according to its extent. In the literature, classification of the extent of PVTT is heterogeneous, and most studies primarily investigated different treatment options, such as transarterial chemoembolization (TACE), radioembolization, resection, radiotherapy or systemic therapy . Only a few of these studies include a detailed classification of PVTT into several subgroups as suggested by Cheng et al or by the Liver Cancer Study Group of Japan .…”

Section: Introductionmentioning

confidence: 99%

Extent of portal vein tumour thrombosis in patients with hepatocellular carcinoma: The more, the worse?

Mähringer‐Kunz

Steinle

Düber

et al. 2018

Liver International

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Background & Aims Portal vein tumour thrombosis (PVTT) has a significant impact on the prognosis of patients with hepatocellular carcinoma (HCC). The degree of PVTT varies from sub‐/segmental invasion to complete occlusion of the main trunk. Aim of this study was to evaluate whether the degree of PVTT correlates with prognosis. Methods A total of 1317 patients with HCC treated at our tertiary referral centre between January 2005 and December 2016 were included. PVTT was diagnosed by contrast‐enhanced computed tomography or magnetic resonance imaging. The extent of PVTT was documented according to the Liver Cancer Study Group of Japan classification: Vp0 = no PVTT, Vp1 = segmental portal vein invasion, Vp2 = right anterior/posterior portal vein, Vp3 = right/left portal vein and Vp4 = main trunk. Median overall survival (OS) was calculated for each group. Results Portal vein tumour thrombosis was present in 484 (36.8%) patients. Median OS without PVTT was 35.7 months, significantly longer than in patients with PVTT (7.2 months, P < 0.001). The patients with PVTT were subclassified as follows: 103 Vp1, 87 Vp2, 143 Vp3 and 151 Vp4. The corresponding median OS yielded 14.6, 9.4, 5.8 and 4.8 months for Vp1‐Vp4, respectively (P < 0.001). Conclusions Portal vein tumour thrombosis in patients with HCC is associated with a dismal prognosis. The results indicate an association between the extent of PVTT and OS. However, the extent of PVTT is not that decisive, as even minor PVTT leads to a very poor prognosis. Therefore, meticulous evaluation of cross‐sectional imaging is crucial for the clinical management of patients with HCC.

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Section: Introductionmentioning

confidence: 99%

Extent of portal vein tumour thrombosis in patients with hepatocellular carcinoma: The more, the worse?

Mähringer‐Kunz

Steinle

Düber

et al. 2018

Liver International

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“…In addition to stage B, treatment option for stage C patients was challenged as well. Numerous studies, mostly from Asian countries, indicated that liver resection can be safe and effective in patients with HCC involving portal vein tumour thrombus . In China, nearly half of patients with primary HCC are diagnosed in an advanced stage .…”

Section: Discussionmentioning

confidence: 99%

Liver resection for hepatocellular carcinoma: personal experiences in a series of 1330 consecutive cases in China

Huang

Yan

et al. 2018

ANZ Journal of Surgery

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“…Several studies have reported that perioperative treatment with hepatectomy could improve the prognosis of HCC patients with PVTT. Previous studies have reported the outcomes of combination treatment based on surgical resection for HCC patients with PVTT (Table ) . The MST and 1‐year OS rate after combination treatment ranged from 11.5 to 37 months and from 46.8% to 100%, respectively.…”

Section: Surgical Resection Combined With Multidisciplinary Treatmentmentioning

confidence: 99%

“…The surgical mortality rate in patients with PVTT who receive surgical resection ranges from 0% to 10% (Table ) . It should be noted that patients who receive surgery are usually carefully selected.…”

Section: Surgical Indications and Procedures For Hcc With Pvttmentioning

confidence: 99%

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Surgical treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus

Sakamoto

2017

Hepatology Research

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The Barcelona Clinic Liver Cancer staging system recommends a tyrosine kinase inhibitor (sorafenib) as standard therapy in advanced hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). Sorafenib has been shown to prolong median overall survival (OS) by approximately 3 months in advanced HCC patients with PVTT (8.1 vs. 4.9 months). However, its clinical effectiveness is still controversial and standard treatment with sorafenib is not established in Japan. Surgical resection is considered a potentially curative treatment and provides an acceptable outcome for carefully selected patients. The surgical mortality rate in patients with PVTT who receive surgical resection ranges from 0% to 10%. The median survival time and 1-year OS rate in HCC patients with PVTT who undergo surgical resection have been found to range from 8 to 22 months and 21.7% to 69.6%, respectively. But improvement in therapeutic outcome is difficult with surgical treatment alone. Combination treatment in conjunction with such methods as transarterial chemoembolization, hepatic artery infusion chemotherapy, and radiotherapy has been found to improve the prognosis (median survival time, 11.5-37 months; 1-year OS rate, 46.8-100%). Yet, many problems remain, such as surgical indications and surgical techniques. After resolving these points, a multidisciplinary strategy based on surgical treatment should be established for advanced HCC with PVTT.

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Appropriate treatment strategies improve survival of hepatocellular carcinoma patients with portal vein tumor thrombus

Abstract: Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and results in high hepatic functional reserve. For patients who can tolerate the procedure, postoperative TACE is necessary to prevent recurrence and prolong the survival period.

Cited by 47 publications

References 24 publications

Extent of portal vein tumour thrombosis in patients with hepatocellular carcinoma: The more, the worse?

Extent of portal vein tumour thrombosis in patients with hepatocellular carcinoma: The more, the worse?

Liver resection for hepatocellular carcinoma: personal experiences in a series of 1330 consecutive cases in China

Surgical treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus

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