Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms: a review and update

Abstract

Portal vein tumor thrombus (PVTT) usually worsens prognosis of hepatocellular carcinoma (HCC), as characterized by aggressive disease progression, impaired liver function and tolerance to treatment. Conventionally, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) accepted the Barcelona Clinical Liver Cancer (BCLC) treatment algorithms, identifying PVTT as an absolute contra-indication of surgical resection for HCC. HCC-PVTT patients are offered sorafenib as the standard treatment. Evidently, SHARP and Asia-Pacific trials demonstrated that sorafenib only improves overall survival by approximately 3 months in patients with advanced HCC. Besides, BCLC treatment algorithm does not provide different therapeutic recommendations for different degree of PVTT, and only supports single treatment option for each stage of HCC rather than a combination of comprehensive treatments, which limited individual and best care for every HCC-PVTT patients. In the past few years, many surgeons do not restrict surgical resection to HCC with PVTT. There have been new reports demonstrated that surgical treatment is feasible for selected HCC-PVTT patients with resectable tumor and moderate liver function to prolong survival period and elevate life quality as long as PVTT limited to the first-order branch, whereas non-surgical treatments fail to provide comparable therapeutic effects. At present, guidelines on HCC management from mainland China, Japan, and Hong Kong have been updated and a consensus of Asia-Pacific experts has established that portal venous invasion is not an absolute contradiction of surgical resection for HCC. This review summarized the emerging data on surgical resection for HCC-PVTT patients beyond the BCLC treatment algorithms and discussed recent therapeutic conceptualchanges in the Asia-Pacific region.

Promising Antineoplastic Actions of Melatonin

“…For many cancer types, such as some hematologic tumors, chemotherapy is the most effective treatment ( Mousavi et al, 2016 ; Bell et al, 2018 ). For other types, surgery is the best option ( Marcasciano et al, 2017 ; Ye et al, 2017 ); when surgery is not possible, chemotherapy can be helpful in stopping tumor growth or reducing its volume ( Wagner et al, 2017 ; Wang et al, 2018 ). Unfortunately, in many cases antitumor drugs are not effective and they often have deleterious side effects ( Iwamoto et al, 2014 ; Li and Caeyenberghs, 2018 ).…”

MicroRNA‑197‑3p acts as a prognostic marker and inhibits cell invasion in hepatocellular carcinoma

“…Hepatocellular carcinoma (HCC) is the third most common cause of cancer-associated mortality worldwide, and the highest numbers of HCC cases have been detected in Asia and Africa (1,2). The long-term prognosis of HCC remains unsatisfactory, as indicated by a low overall survival rate of 22–35% over the last 10 years (3).…”

INTRABEAM intraoperative radiotherapy combined with portal vein infusion chemotherapy for treating hepatocellular carcinoma with portal vein tumor thrombus

“…Patients with HCC can develop portal vein tumor thrombus (PVTT) due to direct extension or by intravascular metastases. The incidence of PVTT in HCC ranges from 10 to 60% [2], which is believed as one of the most reliable prognostic factors for the survival of HCC patients [3]. The median survival time in untreated HCC patients without PVTT is 24.4 months; however, in patients with PVTT, it is 2.7 months [4] and thus, indicates a necessity for curing and controlling PVTT [5].…”