The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus

Zhang, Zong-ming; Lai, Eric C. H.; Zhang, Chong; Yu, Hongwei; Liu, Zhuo; Wan, Bo-jiang; Liu, Limin; Tian, Zhen; Deng, Hai; Sun, Qiuhong; Chen, Xiaoping

doi:10.1016/j.ijsu.2015.05.009

Cited by 136 publications

(87 citation statements)

References 45 publications

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“…For multiple tumors, surgical resection in combination with intraoperative ablation (e.g., intraoperative RFA) can be performed to allow for resection of the tumors along the liver edges and simultaneous ablation of deep tumors. For patients with tumor emboli in the portal vein, the portal venous flow of the unaffected side should be temporarily interrupted during portal vein embolectomy not only for avoiding dissemination of tumor emboli [56] but also for avoiding bleeding. For patients with tumor emboli in the hepatic vein or vena cava, total vascular occlusion can be performed to ensure the removal of the whole tumor emboli [57, 58].…”

Section: Treatmentmentioning

confidence: 99%

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Zhou¹,

Sun²,

Wang³

et al. 2018

Liver Cancer

480

449

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Background: Hepatocellular carcinoma (HCC) (about 85–90% of primary liver cancer) is particularly prevalent in China because of the high prevalence of chronic hepatitis B infection. HCC is the fourth most common malignancy and the third leading cause of tumor-related deaths in China. It poses a significant threat to the life and health of Chinese people. Summary: This guideline presents official recommendations of the National Health and Family Planning Commission of the People’s Republic of China on the surveillance, diagnosis, staging, and treatment of HCC occurring in China. The guideline was written by more than 50 experts in the field of HCC in China (including liver surgeons, medical oncologists, hepatologists, interventional radiologists, and diagnostic radiologists) on the basis of recent evidence and expert opinions, balance of benefits and harms, cost-benefit strategies, and other clinical considerations. Key Messages: The guideline presents the Chinese staging system, and recommendations regarding patients with HCC in China to ensure optimum patient outcomes.

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Section: Treatmentmentioning

confidence: 99%

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Zhou¹,

Sun²,

Wang³

et al. 2018

Liver Cancer

480

449

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“…Portal vein tumor thrombosis (PVTT) is the most commonly recognized risk factor for prognosis. PVTT occurs in 44-62.2% of patients with advanced HCC and is associated with a natural median survival time (MST) of 2.7-4 months [3, 4]. Despite recent advances in the treatment of such patients, the treatment strategies for patients with HCC with PVTT remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Transarterial chemoembolization (TACE) combined with sorafenib versus TACE for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

Zhang

Wang

et al. 2017

Oncotarget

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BackgroundThe benefits of transarterial chemoembolization plus sorafenib (TACE-S) in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remain controversial. We compared the effectiveness and safety of TACE-S and TACE for HCC with PVTT.MethodsThe Cochrane Library, PubMed, EMBASE, Chinese National Knowledge Infrastructure, VIP, Wan Fang, and Sino Med databases were systematically searched for studies of HCC with PVTT treated using TACE-S. Two authors independently extracted study outcomes, including overall survival (OS), time to progression (TTP), objective response (tumor response) and adverse events (AEs).ResultsEight high-quality, retrospective studies with 1091 patients (TACE-S=356, TACE=735) were included in the review. Five retrospective studies with 973 patients (TACE-S=238, TACE=735) were included in the meta-analysis. The objective response rate (ORR, OR=3.59, 95% CI=1.74–7.39; I2=21%, P=0.0005) and disease control rate (DCR, OR=4.72, 95% CI=1.75–12.72; I2=56%, P=0.002) favored TACE-S. TACE-S significantly increased 6-month OS (OR=3.47; 95% CI=2.47–4.89; I2=0%, P < 0.00001) and 1-year OS (OR=3.10; 95% CI=2.22–4.33; I2=41%, P < 0.00001). The hazard ratio (HR) for OS (HR=0.62; 95% CI=0.51–0.75; I2=30%, P < 0.00001) also indicated that TACE-S was superior to TACE. TACE-S with PVTT had better outcomes in the first-order portal vein branch and lower-order portal vein branches than in the main portal vein and upper branches to superior mesenteric vein. The most common AEs were hand-foot skin reaction (HFSR, 178; 73%), diarrhea (142; 58%) and alopecia (76; 31%); AEs of grade 3/4 were rare.ConclusionsTACE-S may improve OS, ORR, TTP and DCR for HCC patients with PVTT compared to TACE.

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“…HCC is prone to invading intrahepatic vessels especially the portal vein system. It is reported that the incidence of portal vein tumor thrombus (PVTT) is 44%-62.2% [4], much higher than that of hepatic vein tumor thrombus (HVTT)/inferior vena cava tumor thrombus (IVCTT) and bile duct tumor thrombus (BDT) which is 0.7%-20% and 1.84%-13%, separately [4–6]. PVTT could result in intrahepatic and extrahepatic metastases, portal hypertension, jaundice, and ascites and it was reported to have a median survival time of only 2.7 months.…”

Section: Introductionmentioning

confidence: 99%

“…Vascular invasion of HCC is divided into macrovascular invasion and microvascular invasion (MVI). Portal vein tumor thrombus (PVTT), which refers to the tumor thrombus in the main portal vein and its branches, is the most common macrovascular invasion and a frequent complication of HCC [4]. MVI is defined as nest-like cancer cells can be seen in vessel lumen covered with endotheliocytes under microscope [7].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus - Eastern Hepatobiliary Surgical Hospital consensus statement

et al. 2016

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Hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus (PVTT) is associated with poor prognosis, early recurrence of HCC, and limited treatment options. Current guidelines do not have standardized diagnostic and treatment modalities, thus creating a need for a multidisciplinary treatment model for standardization of the treatment. Eastern Hepatobiliary Surgical Hospital (China) convened two working parties of experts from all the departments, to consolidate the current evidence, prevailing vision for the future, and experience of the practicing clinicians engaged in HCC management, so as to develop a consensus for PVTT diagnosis and treatment according to the GRADE system. Based on the quality of the existing evidence and the strength of recommendations, the consensus statements were categorized into 3 evidence levels (A/B/C) and 5 classes (I/II/IIa/IIb/III). The panel discussed and provided clarity on the management and research options in the field of HCC with PVTT. In addition, the panel also assessed the quality of the cited studies and assigned grades to the recommendation statements. Among the group of experts, there was excellent agreement with regard to effective diagnosis and treatment of HCC with PVTT. The recommendations of this consensus will provide guidance to physicians and clinical researchers on the effective management of HCC with PVTT.

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The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus

Cited by 136 publications

References 45 publications

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Transarterial chemoembolization (TACE) combined with sorafenib versus TACE for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus - Eastern Hepatobiliary Surgical Hospital consensus statement

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