New Evidence and Perspectives on the Management of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

Yin, Jun; Bo, Wentao; Sun, Jian; Xiang, Xiao; Lang, Jinyi; Zhong, Jian‐Hong; Li, Le‐Qun

doi:10.14218/jcth.2016.00071

Cited by 18 publications

(14 citation statements)

References 99 publications

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“…TACE is considered the preferential palliative therapy for multinodular HCC for patients with well-preserved liver function. TACE usefulness in PVTT, especially in type III/IV, remains uncertain, because of the limited effect on survival compared to systemic treatments and the potential risk of ischemia related post-TACE liver function failure; this risk appears increased if the collateral blood circulation surrounding the obstructed portal vein is insufficient[59-61]. The main studies concerning TACE in PVTT patients are summarized in Table 1.…”

Section: Treatment Options For Hcc With Pvtt: State Of the Art And Pomentioning

confidence: 99%

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Cerrito

Annicchiarico

Iezzi

et al. 2019

WJG

104

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Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide: Portal vein tumor thrombosis (PVTT) occurs in about 35%-50% of patients and represents a strong negative prognostic factor, due to the increased risk of tumor spread into the bloodstream, leading to a high recurrence risk. For this reason, it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care, due to its antiangiogenetic action, although it can grant only a poor prolongation of life expectancy. Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition, including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement, tumor biological aggressiveness, complications caused by portal hypertension, patient’s clinical features and tolerance to antineoplastic treatments. The median survival has been reported to range between 2.7 and 4 mo in absence of therapy, but it can vary from 5 mo to 5 years, thus depicting an extremely variable scenario. For this reason, it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients.

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Section: Treatment Options For Hcc With Pvtt: State Of the Art And Pomentioning

confidence: 99%

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Cerrito

Annicchiarico

Iezzi

et al. 2019

WJG

104

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“…Patients with MiVI may benefit from anatomical liver resection, transcatheter therapy, and radiotherapy. − Despite recent diagnosis and treatment options improved, the prognosis of HCC with MaVI remains dismal. It has been reported that the median survival of HCC patients with MaVI is only between 2 and 6 months with supportive care. ,, MaVI is traditionally considered as a contraindication for surgical resection − though several inconsistent studies reported survival of HCC with MaVI was improved by radical surgical procedures. International guidelines including the Barcelona Clinic Liver Cancer system, the European Association for the Study of Liver Disease, and the Asian Pacific Association for the Study of the Liver recommend sorafenib as the only option for advanced HCC with MaVI. , However, sorafenib can only slightly improve the survival by 1–3 months. ,, …”

Section: Introductionmentioning

confidence: 99%

Significant Down-Regulation of Urea Cycle Generates Clinically Relevant Proteomic Signature in Hepatocellular Carcinoma Patients with Macrovascular Invasion

et al. 2019

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Vascular invasion is considered as the critical risk factor of hepatocellular carcinoma (HCC). To reveal the molecular mechanisms underlying macrovascular invasion (MaVI) in HCC, we performed an iTRAQ based proteomic study to identify notably dysregulated proteins from eight HCC patients with differential vascular invasion and further confirmed them in the other 53 HCC patients. Forty-seven proteins were found significantly down-regulated in HCC with MaVI. More importantly, 30 of them were not changed in HCC without MaVI. Gene ontology analysis of these 47 proteins shows the top three enriched biological processes are urea cycle, gluconeogenesis, and arginine biosynthetic process. We validated nine remarkably dysregulated candidates in HCC patients with MaVI by Western blot including eight down-regulated proteins (CPS1, ASS1, ASL, ARG1, BHMT, DMGDH, Annexin A6, and CES1) and one up-regulated protein (CKAP4). Furthermore, dysregulation of CPS1, ASL, and ARG1, key enzymes involved in urea cycle, together with Annexin A6 and CES1, major proteins in regulating cholesterol homeostasis and fatty acid ester metabolism, was verified using immunohistochemical staining. The significant down-regulation of urea cycle generates clinically relevant proteomic signature in HCC patients with macrovascular invasion, which may provide possible insights into the molecular mechanisms of metastasis and new therapeutic targets of HCC.

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“…In recent years, with the progress and development of surgical concepts, radiotherapy techniques, targeted drugs and immunotherapy, patients with HCC involving PVTT have more treatment options and their prognoses have been significantly improved. 14 – 17 These therapeutic methods have different mechanisms of action ( Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Current Status and Controversy

Deng¹,

Le²,

Teng³

et al. 2021

J Clin Transl Hepatol

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Background and Aims: Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investigate the clinical course of patients at specific time points, and to propose dynamic prognostic criteria. Methods: We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study. The clinical course of patients was defined as disease recovery, improvement, worsening or steady patterns based on the variation tendency in prothrombin activity (PTA) and total bilirubin (TB) at different time points. Results: Resolution of PTA was observed in 231 patients (51%) at 12 weeks after the diagnosis of ACLF. Among the remaining patients, 66 (14.6%) showed improvement and 156 (34.4%) showed a steady or worsening course. In patients with resolved PTA, the clinical course of TB exhibited resolved pattern in 95.2%, improved in 3.9%, and steady or worse in 0.8%. Correspondingly, in patients with improved PTA, these values for TB were 28.8%, 27.3%, and 43.9%, respectively. In patients with steady or worsening PTA, these values for TB were 5.7%, 32.3%, and 65.6%, respectively. Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients. Conclusions: We propose the following dynamic prognostic criteria: rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence, which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.

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New Evidence and Perspectives on the Management of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

Cited by 18 publications

References 99 publications

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Significant Down-Regulation of Urea Cycle Generates Clinically Relevant Proteomic Signature in Hepatocellular Carcinoma Patients with Macrovascular Invasion

Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Current Status and Controversy

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