Growth velocity of the portal vein tumor thrombus accelerated by its progression, alpha-fetoprotein level, and liver fibrosis stage in patients with hepatocellular carcinoma

Gon, Hidetoshi; Kido, Masahiro; Tanaka, Motofumi; Kinoshita, Hisoka; Komatsu, Shohei; Tsugawa, Daisuke; Awazu, Midori; Toyama, Hirochika; Matsumoto, Ippei; Itoh, Tomoo; Fukumoto, Takumi

doi:10.1016/j.surg.2018.06.025

Cited by 14 publications

(13 citation statements)

References 28 publications

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“…It was reported that the average growth velocity of portal vein tumor thrombus is 0.9 ± 1.0 mm/day in HCC patients. Based on the rapid progression of TIV, defining an appropriate interval between CEUS imaging and standard reference becomes important [43]. In our review, the assessment of flow and timing in QUADAS-2 tool was at risk, and further studies should take this interval with caution to get more convincing results.…”

Section: Discussionmentioning

confidence: 95%

Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis

et al. 2020

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Objectives Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. However, differentiation of thrombosis and tumor-in-vein (TIV) may be challenging. Contrast-enhanced ultrasound (CEUS) is an excellent method for detection of vascularization and could help in the distinction. We performed a systematic review and meta-analysis for evaluating the diagnostic value of CEUS in differentiating between PVT and TIV in hepatocellular carcinoma (HCC) patients. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched up to the 5th of May 2019. The study quality was assessed by QUADAS-2 tool. Pooled sensitivity and specificity were calculated by the bivariate random effect model and hierarchical summary receiver-operating characteristic (SROC) curve was plotted. Results Seven studies including 425 participants were analyzed after screening 986 articles searched from databases. The pooled sensitivity and specificity of CEUS in diagnosing TIV were 0.94 (95%CI, 0.89-0.97) and 0.99 (95%CI, 0.80-1.00), respectively. The area under the curve (AUC) of SROC curve was 0.97 (95%CI, 0.95-0.98). The pooled sensitivity and AUC were consistent across all the subgroups of different subject numbers, country, study design, CEUS contrast agents, and diagnostic criteria. Conclusions CEUS is highly efficient in differentiating TIV from PVT and is an alternative or a substitute for CT and/or MRI. Trial registration PROSPERO registration number: CRD42019138847 Key Points • Characterization of portal vein thrombosis (PVT) vs tumor-in-vein (TIV) is critical for HCC staging. • CEUS has an excellent safety profile, provides a real-time analysis without any loss in accuracy compared with CT and MRI. • This meta-analysis demonstrates that contrast-enhanced ultrasound (CEUS) is a suitable method for the detection of PVT and distinction with TIV.

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Section: Discussionmentioning

confidence: 95%

Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis

et al. 2020

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“…47 A study reported that the estimated time for a tumor thrombus (TT) that is present in the 2nd portal branch to grow into the ipsilateral 1st portal branch and from the 1st portal branch to the main portal vein trunk was 8.2 and 11.5 days (median estimated time), respectively. 48 The extent of the PVTT itself is an independent risk factor for rapid progression of TT. The presence and extension of vascular invasion along with the performance status and ascites have a significant impact on patient survival and the choice of therapeutics.…”

Section: Risk Factors For Pvtt Formationmentioning

confidence: 99%

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

Khan¹,

Wei²,

Xu³

2021

JHC

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Portal vein involvement is considered one of the most fearful complications of hepatocellular carcinoma (HCC). Portal vein tumor thrombosis (PVTT) is associated with aggressive tumor biology (high grade), high tumor burden (number and size of lesions), high levels of serum markers (AFP), poor liver function (deranged LFT), and poor performance status of patients. The Barcelona Clinic Liver Cancer staging system places HCC patients with PVTT in advanced stage (BCLC Stage-C). This group contains a fairly heterogeneous patient population, previously considered candidates for palliative systemic therapy with sorafenib. However, this provided modest overall survival (OS) benefit. The results of a recent Phase III (IMbrave150) trial favor the combination of atezolizumab and bevacizumab over sorafenib as a standard of care in advanced unresectable HCC. While only lenvatinib proved to be non-inferior against sorafenib in a phase III (REFLECT trial), regorafenib (RESORCE trial), ramucirumab (REACH-2), and cabozantinib (CELESTIAL) have been approved second-line therapy in phase III clinical trials. Recently, the data on the prospect of other modalities in the management of HCC with PVTT is mounting with favorable results. Targeting multiple pathways in the HCC cascade using a combination of drugs and other modalities such as RT, TACE, TARE, and HAIC appear effective for systemic and loco-regional control. The quest for the ideal combination therapy and the sequence set is still widely unanswered and prospective trials are lacking. With the armament of available therapeutic options and the advances and refinements in the delivery system, down-staging patients to make them eligible for curative resection has been reported. In a rapidly evolving treatment landscape, performing surgery when appropriate, in the form of LR and even LT to achieve cure does not seem farfetched. Likewise, adjuvant therapy and prompt management of the recurrences holds the key to prolong OS and DFS. This review discusses the management options of HCC patients with PVTT.

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“…A recent study reported that HBV infection and activity of the TGF-b-miR-34a-CCL22 axis might be related to the development of PVTT (28). Others have shown that liver fibrosis, severity of PVTT, and proteins induced by vitamin K absence or antagonist II (PIVKA-II) were independent prognostic factors for survival of HCC patients with PVTT (29). In contrast, a low serum concentration of desγ-carboxy prothrombin combined with curative resection of HCC with main portal vein PVTT was associated with improved 5-year survival (30).…”

Section: Discussionmentioning

confidence: 99%

Impact of splenomegaly and splenectomy on prognosis in hepatocellular carcinoma with portal vein tumor thrombus treated with hepatectomy

Chai¹,

Zhang²,

Shao³

et al. 2021

Ann Transl Med

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Background: Hepatocellular carcinoma (HCC) commonly occurs in patients with splenomegaly. This study aimed to investigate the impact of splenomegaly with or without splenectomy on long-term survival of HCC patients with portal vein tumor thrombus (PVTT) treated with liver resection (LR).Methods: HCC patients with PVTT who underwent LR from 2005 to 2012 from 6 hospitals were retrospectively studied. The long-term overall survival (OS) and recurrence-free survival (RFS) were compared between patients with or without splenomegaly, and between patients who did or did not undergo splenectomy for splenomegaly. Propensity score matching (PSM) analysis was performed to match patients in a 1:1 ratio. Results: Of 716 HCC patients with PVTT who underwent LR, 140 patients had splenomegaly (SM group) and 576 patients had no splenomegaly (non-SM group). The SM group was further subdivided into 49 patients who underwent splenectomy (SPT group), and 91 patients who did not received splenectomy (non-SPT group). PSM matched 140 patients in the SM group, and 49 patients in the SPT group. Splenomegaly was an independent risk factor of poor RFS and OS. The OS and RFS rates were significantly better for patients in the non-SM group than the SM group (OS: P<0.001; RFS: P<0.001), and for patients in the SPT group than the non-SPT group (OS: P<0.001; RFS: P<0.001).Conclusions: Patients who had splenomegaly had significantly worse survival in HCC patients with PVTT. Splenectomy for splenomegaly significantly improved long-term survival in these patients.

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Growth velocity of the portal vein tumor thrombus accelerated by its progression, alpha-fetoprotein level, and liver fibrosis stage in patients with hepatocellular carcinoma

Cited by 14 publications

References 28 publications

Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis

Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

Impact of splenomegaly and splenectomy on prognosis in hepatocellular carcinoma with portal vein tumor thrombus treated with hepatectomy

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