Macroscopic Portal Vein Thrombosis in HCC Patients

Abstract

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD <5cm to 56.4% with tumors of MTD >10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development.

<p>Adjuvant trans-arterial chemoembolization after hepatectomy significantly improves the prognosis of low-risk patients with R0-stage hepatocellular carcinoma</p>

“…Some randomized controlled studies have been indicated that adjuvant PA-TACE treatment could archive clinical benefits for patients suffering from HCC larger than 5 cm (<5 cm) in diameter, macroscopic vascular invasion or multiple nodules 30–32. Similar results were observed in clinical studies focused on prognosis analysis of patients with m-PVTT (macroscopic portal vein tumor thrombus) after surgical operation 33–35…”

Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter

“…HCC aggressiveness factors of PVT, AFP, or multifocality have been previously shown to correlate with the increase in tumor size or MTD. [22][23][24][25][26][27] Whether this is causal or mere association has not been clarified. The two most likely hypotheses to explain the relation of size to other aggressiveness factors are the probability of aggressiveness factors per increased unit of tumor size versus an increased tumor size producing more factors that stimulate tumor invasiveness.…”

Liver transplant for large hepatocellular carcinoma in Malatya: The role of gamma glutamyl transferase and alpha-fetoprotein, a retrospective cohort study

“…Or does 5 cm mark a watershed in HCC biology, with > 5 cm tumors exhibiting more aggressive features? A partial answer is that there is an increase in portal vein invasion and in AFP levels with an increase in HCC size[ 18 ]. This may explain the high (70%) incidence of PVT positivity in these larger tumors, as shown in Table 1 and 2 .…”