Portal vein tumor thrombus is a bottleneck in the treatment of hepatocellular carcinoma

Abstract

The effect of portal vein tumor thrombus (PVTT) on the prognosis of patients with hepatocellular carcinoma has become clear over the past several decades. However, identifying the mechanisms and performing the diagnosis and treatment of PVTT remain challenging. Therefore, this study aimed to summarize the progress in these areas. A computerized literature search in Medline and EMBASE was performed with the following combinations of search terms: “hepatocellular carcinoma” AND “portal vein tumor thrombus.” Although several signal transduction or molecular pathways related to PVTT have been identified, the exact mechanisms of PVTT are still largely unknown. Many biomarkers have been reported to detect microvascular invasion, but none have proved to be clinically useful because of their low accuracy rates. Sorafenib is the only recommended therapeutic strategy in Western countries. However, more treatment options are recommended in Eastern countries, including surgery, radiotherapy (RT), transhepatic arterial chemoembolization (TACE), transarterial radioembolization (TARE), and sorafenib. Therefore, we established a staging system based on the extent of portal vein invasion. Our staging system effectively predicts the long-term survival of PVTT patients. Currently, several clinical trials had shown that surgery is effective and safe in some PVTT patients. RT, TARE, and TACE can also be performed safely in patients with good liver function. However, only a few comparative clinical trials had compared the effectiveness of these treatments. Therefore, more randomized controlled trials examining the extent of PVTT should be conducted in the future.

Therapeutic Evaluation of Radiotherapy with Contrast-Enhanced Ultrasound in Non-Resectable Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombosis

“…After 3DCRT, there were 38 cases that had PVTT type decreasing [ 24 ], and the downstaging rate was 48.1% (38 out of 79) ( Table 1 ). There were 45 cases of PR in HCC, the efficiency rate was 57% (45 out of 79).…”

Dose and Location of Irradiation Determine Survival for Patients with Hepatocellular Carcinoma with Macrovascular Invasion in External Beam Radiation Therapy

“…The prognosis with respect to OS of advanced HCC with MVI or extrahepatic metastasis is generally reported as 3–6 months [22]. Sorafenib is described as the first recommended treatment for these advanced HCC patients in the established therapeutic guidelines [23, 24].…”

“…Li et al[29] also reported that EBRT with HAIC for MVI in HCC showed promising results in a meta-analysis using 15 studies published between 2010 and 2016 involving a total of 2,359 patients with advanced HCC with MVI. According to a large body of evidence, radioembolization is also an important treatment method for patients with advanced HCC with MVI [22, 30, 31], as it yields average DCR above 80% and is very well tolerated. Many reports show that radioembolization adds significant value to the therapeutic weaponry against advanced HCC.…”

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

“…In recent decades, some new concepts in the management of HCC with PVTT have emerged 13. This review aims to discuss the current status and future prospect of the management of HCC with PVTT.…”