Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Current Status and Controversy

Abstract

Background and Aims: Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investigate the clinical course of patients at specific time points, and to propose dynamic prognostic criteria. Methods: We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study. The clinical course of patients was defined as disease recovery, improvement, worsening or steady patterns based on the variation tendency in prothrombin activity (PTA) and total bilirubin (TB) at different time points. Results: Resolution of PTA was observed in 231 patients (51%) at 12 weeks after the diagnosis of ACLF. Among the remaining patients, 66 (14.6%) showed improvement and 156 (34.4%) showed a steady or worsening course. In patients with resolved PTA, the clinical course of TB exhibited resolved pattern in 95.2%, improved in 3.9%, and steady or worse in 0.8%. Correspondingly, in patients with improved PTA, these values for TB were 28.8%, 27.3%, and 43.9%, respectively. In patients with steady or worsening PTA, these values for TB were 5.7%, 32.3%, and 65.6%, respectively. Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients. Conclusions: We propose the following dynamic prognostic criteria: rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence, which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.

Hepatic stellate cell exosome-derived circWDR25 promotes the progression of hepatocellular carcinoma <i>via</i> the miRNA-4474-3P-ALOX-15 and EMT axes

“…Hepatocellular carcinoma (HCC) is one of the most malignant tumors, accounting for approximately 90% of all cases of primary liver cancer, and it is gradually becoming the second deadliest tumor globally (1)(2)(3). Although rational approaches to the diagnosis and treatment of HCC have been developed, the longterm outcomes are unfortunately still generally poor due to its high metastatic ability as well as its high recurrence rate (4)(5)(6).…”

Radiosensitization effect by HDAC inhibition improves NKG2D-dependent natural killer cytotoxicity in hepatocellular carcinoma

“…With recent advancement of surgical techniques, RT technology, targeted therapy and immunotherapy, patients with HCC have more treatment options with the significantly improved prognosis. As the importance of external RT gradually increases in multidisciplinary treatment of HCC patients HCC, RT combined with other treatment modalities may provide the utmost benefit of advanced disease ( 19 ).…”

Case Report: Combining liver partition and portal vein ligation after thrombectomy for tumor isolation (CLAPT) to treat advanced hepatocellular carcinoma with portal vein tumor thrombosis

“…Increasing lines of evidence show that surgical treatment can improve the prognosis of patients with HCC combined with PVTT. A literature review shows that hepatic resection is the most effective therapy for patients with HCC and PVTT ( 19 ). Roayaie et al ( 20 ) showed that for patients with large blood vessel invasion, Child–Pugh A liver function, and BCLC C stage who underwent surgical resection, the median survival time was significantly higher than that in patients who only used drugs.…”