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

Mähringer‐Kunz, Aline; Steinle, Verena; Düber, Christoph; Weinmann, Arndt; Koch, Sandra; Schmidtmann, Irene; Schotten, Sebastian; Hinrichs, Jan B.; Graafen, Dirk; Santos, Daniel Pinto dos; Galle, Peter R.; Kloeckner, Roman

doi:10.1111/liv.13988

Cited by 63 publications

(64 citation statements)

References 33 publications

(60 reference statements)

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“…125 Interestingly, the presence of either MVI/PVTT or PVT is associated with poor survival in patients with HCC. 126 Studies have shown that for patients with PVTT, prognosis depends on grade, with median survivals of just 2-5 months reported in patients with PVTT of the main trunk. 126,127 Patients with HCC and diagnosed PVTT have advanced disease (BCLC stage C).…”

Section: Patients With Vascular Invasion or Portal Vein Thrombosismentioning

confidence: 99%

Systemic treatment of HCC in special populations

Rimassa

Personeni

Czauderna

et al. 2021

Journal of Hepatology

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Recent years have seen significant progress in the systemic treatment of hepatocellular carcinoma (HCC), including the advent of immunotherapy. While several large phase III trials have provided the evidence for a multi-line treatment paradigm, they have focused on a highly selected group of patients by excluding potentially confounding comorbidities. As a result, high quality evidence for the systemic treatment of HCC in patients with various comorbidities is missing. This review summarises current knowledge on the use of approved medicines in patients with HIV, autoimmune disease, cardiovascular disease, diabetes, fibrolamellar HCC, mixed HCC-cholangiocarcinoma, decompensated cirrhosis (Child-Pugh B and C), a significant bleeding history, vascular invasion or portal vein thrombosis, as well as the elderly, those on haemodialysis, and those after solid organ transplantation. The article highlights relevant knowledge gaps and current clinical challenges. To improve the safety and efficacy of HCC treatment in these subgroups, future trials should be designed to specifically include patients with comorbidities.

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Section: Patients With Vascular Invasion or Portal Vein Thrombosismentioning

confidence: 99%

Systemic treatment of HCC in special populations

Rimassa

Personeni

Czauderna

et al. 2021

Journal of Hepatology

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“…The extent of PVTT was classified as follows: Vp0, no PVTT; Vp1, segmental PV invasion; Vp2, right anterior or posterior PV; Vp3, right or left PV; and Vp4, main trunk and/or contralateral portal vein branch to the primarily involved lobe. 12,13,17 Inclusion criteria for TKI treatment were as follows: having metastatic or locally advanced HCC that was unresectable or refractory to transarterial chemoembolization with BCLC stage B or C 9 and Eastern Cooperative Oncology Group performance status 0 to 1. 26 The reasons why patients received additional therapy were mainly discontinuation of TKI therapy due to any unacceptable or serious adverse events (AEs) or tumor progression.…”

Section: Patientsmentioning

confidence: 99%

“…Regarding tumor PVTT, 224 (64.9%), 48 (13.9%), and 70 (20.2%) patients had Vp0, 1/2, and 3/4 as classified by previous reports. 12,13,17 Median TKI treatment duration was 115 days.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The report indicated an association between OS and the extent of PVTT. 17 As previously described, liver function and PVTT should be considered in the management of advanced HCC (BCLC-C). However, there are few reports about the association between ALBI score and the extent of PVTT.…”

Section: Introductionmentioning

confidence: 98%

“…However, incidence and survival according to the degree of PVTT has recently been reported in an European group. 17 Portal vein tumor thrombosis in patients with HCC is associated with a poor prognosis. The report indicated an association between OS and the extent of PVTT.…”

Section: Introductionmentioning

confidence: 99%

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Strategy for advanced hepatocellular carcinoma based on liver function and portal vein tumor thrombosis

Kaneko

Tsuchiya

Yasui

et al. 2020

Hepatology Research

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Tyrosine kinase inhibitor (TKI) therapy resulted in better prognosis for patients with hepatocellular carcinoma (HCC). However, some cases with Barcelona Clinic Liver Cancer (BCLC) stage C disease still had poor prognosis. This study aimed to investigate prognosis and characteristics of patients with HCC treated with TKI based on liver function and the extent of portal vein tumor thrombosis (PVTT). Methods: Patients receiving TKI therapy (n=345) were recruited retrospectively. Child-Pugh score and albumin-bilirubin (ALBI) score were used for assessment of liver function. The extent of PVTT was classified from Vp0 to Vp4. Radiotherapy or hepatic arterial infusion chemotherapy were carried out as additional therapy to TKI. The end point for this analysis was overall survival (OS). Results: A total of 291 and 54 patients received sorafenib and lenvatinib as first line TKI therapy, respectively. The median OS of patients treated with TKI were significantly stratified by ALBI grade (grade 1, 20.1 months; grade 2a, 16.3 months; grades 2b and 3, 9.8 months; P=0.0003). The classification of PVTT significantly stratified the prognosis of patients treated with TKI (median OS: Vp0, 18.5 months; Vp1/2, 14.4 months; Vp3/4, 5.5 months; P<0.0001). In the ALBI 2b/3 and Vp3/4 groups, the median OS of patients treated with TKI and additional therapies was significantly longer than those treated with TKI only (9.2 months vs.. 3.6 months; P=0.0129). Conclusion: Liver function and PVTT are useful for stratifying prognosis of HCC patients treated with TKI. The applicative classification could lead to appropriate therapy and better prognosis.

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Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance

et al. 2021

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Background There is strong evidence that portal vein tumor thrombosis (PVTT) is associated with poor survival in patients with hepatocellular carcinoma (HCC). However, data regarding the clinical significance of hepatic vein tumor thrombosis (HVTT) is rare, particularly in Western patients. Objective To determine the HVTT prevalence in a Western patient population and its impact on survival. Methods We included 1310 patients with HCC treated in our tertiary referral center between January 2005 and December 2016. HVTT and PVTT were diagnosed with contrast‐enhanced cross‐sectional imaging. Overall survival (OS) was calculated starting from the initial HCC diagnosis, and in a second step, starting from the first appearance of vascular invasion. Results We observed macrovascular invasion (MVI) in 519 patients who suffered from either isolated HVTT (n = 40), isolated PVTT (n = 352), or both combined (HVTT + PVTT) (n = 127). Calculated from the initial HCC diagnosis, the median OS for patients with isolated HVTT was significantly shorter than that of patients without MVI (13.3 vs. 32.5 months, p < 0.001). Calculated from the first appearance of MVI, the median OS was similar among patients with isolated HVTT (6.5 months), isolated PVTT (5 months), and HVTT + PVTT (5 months). Multivariate analysis confirmed HVTT as an independent risk factor for poor survival. Conclusions HVTT may be more common than typically reported. In most patients, it was accompanied by PVTT. Isolated HVTT occurred less frequently and later than isolated PVTT; however, once developed, it had the same deleterious impact on survival. Therefore, patients with HVTT should be classified as advanced stage of HCC.

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

Cited by 63 publications

References 33 publications

Systemic treatment of HCC in special populations

Systemic treatment of HCC in special populations

Strategy for advanced hepatocellular carcinoma based on liver function and portal vein tumor thrombosis

Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance

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