Comprehensive treatments for hepatocellular carcinoma with portal vein tumor thrombosis

Abstract

Portal vein tumor thrombosis (PVTT) is one of the most common complications in hepatocellular carcinoma (HCC). HCC with PVTT usually indicates poor prognosis, which has a number of characteristics including a rapidly progressive disease course, worse liver function, complications connected with portal hypertension, and poorer tolerance to treatment. The exact mechanisms of PVTT remain unknown, even though some concerned signal transduction or molecular pathways have been identified. In western countries, sorafenib is the only recommended therapeutic strategy regardless of PVTT types. However, multiple treatment options including transhepatic arterial chemoembolization, hepatectomy, radiotherapy, and sorafenib available in the clinic. In this review, we enumerate and discuss therapeutics against patients with HCC having PVTT available in the clinic and put forward directions for future research.

<p>Safety and Efficacy of Camrelizumab Combined with Apatinib for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Multicenter Retrospective Study</p>

“…Poor outcomes for advanced HCC remain a great challenge, especially for patients with PVTT, as PVTT may cause extensive intrahepatic spread and portal hypertension, resulting in a high degree of malignancy and treatment difficulties. 32,33 The recommended treatment strategies for PVTT patients are sorafenib and TACE according to BCLC. 8 However, both therapies remained unsatisfactory in our daily clinical application.…”

Treatment of Hepatocellular Carcinoma-associated Portal Vein Tumor Thrombus Using Combination of Portal Vein Stent Insertion and Endovascular Lodine-125 Seed-strip Implantation Followed by Transcatheter Arterial Chemoembolization- Sorafenib

“…For these reasons, HCC patients with PVTT often have a poor prognosis [20]. While liver resection can cure some patients with type I-III HCC [21,22]. However, these patients typically exhibit poor long-term survival following surgery as HCC commonly recurs, particularly in the case of early recurrence within 1 year post-surgery [23].…”

Living donor liver transplantation for patients with advanced hepatocellular carcinoma

“…Imaging techniques including CT and MRI are among the most used diagnostic tools. However, characterization of tumor properties such as invasion into segmental branches of the portal vein can be difficult to assess with these modalities alone [26] . While biomarkers and cutoff levels vary among centers and within the literature, the most widely used are AFP, PIVKA-II, γ-GT/ ALT ratio, and recently proposed inflammatory markers including CRP, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio [22,[26][27][28] .…”

“…HAIC: hepatic arterial infusion chemotherapy; IFN-alpha 2b: interferon alfa-2b; LT: liver transplantation; RT: radiation therapy; TACE: transarterial chemoembolization; TARE: transarterial radioembolization; 5-FU: 5-fluorouracil. *Under certain conditions; **not enough support [26,34,35,38,37,40,41] long-term survival outcomes among carefully selected patients under specific criteria such as: (a) PVTT in a segmental branch, (b) AFP level < 100ng/mL, (c) low AP score, and (d) patients with HCC and PVTT who were successfully downstaged [36,42,43] .…”