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

Abstract

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.

Tumor Burden in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Head-to-Head Comparison of Current Scoring Systems

“…Apart from tumor burden and liver function, several other biomarkers play an important role in the evaluation of patients with HCC. Macrovascular tumor invasion has been identified as an independent factor in these patients ( 38 , 39 ). Although macrovascular invasion appears more often in patients with higher tumor burden, it is not necessarily associated to multifocal tumor growth ( 40 ).…”

Transarterial chemoembolization for omental vein tumor thrombosis in hepatocellular carcinoma: a case report

“…The incidence of PVTT varies widely, occurring in 6.5% to 44% of HCC patients, whereas HVTT alone is seen in only 3% ( 3 ). According to Mähringer-Kunz et al ’s study, HVTT occurs concomitantly with PVTT in 26.9% of cases ( 4 ). The guidelines from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases currently recognize tumor thrombosis primarily in the portal vein ( 1 , 5 ).…”

Identification of risk and prognostic factors for intrahepatic vascular invasion in patients with hepatocellular carcinoma: a population-based study

“…In contrast, the incidence of hepatic vein tumor thrombus (HVTT) is relatively low and ranges from 1.4% to 4.9% ( 10 , 11 ). HCC associated with PVTT or HVTT is regarded as advanced HCC, which is related with poor prognosis ( 12 , 13 ). Once PVTT occurs, it progresses rapidly to cause severe complications, such as portal hypertension, hepatocellular jaundice, and intractable ascites.…”