Copyright
©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016
Stephen L Chan, Charing CN Chong, Anthony WH Chan, Darren MC Poon, Kenneth SH Chok
Stephen L Chan, State Key Laboratory in Oncology of South China, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
Stephen L Chan, Darren MC Poon, Department of Clinical Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
Charing CN Chong, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
Anthony WH Chan, State Key Laborator in Oncology of South China, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
Kenneth SH Chok, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
Author contributions: Chan SL and Chok KSH designed the research; Chan SL, Chong CCN, Chan AWH, Poon DMC and Chok KSH performed the research; Chan SL, Chong CCN, Chan AWH, Poon DMC and Chok KSH analyzed the data; and Chan SL, Chong CCN, Chan AWH, Poon DMC and Chok KSH wrote the paper. An author may list more than one contribution, and more than one author may have contributed to the same aspect.
Supported by the Hong Kong Research Grants Council General Research Fund Scheme, No. 462013.
Conflict-of-interest statement: Stephen L Chan has acted as an advisor to Novartis and MSD.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stephen L Chan, Department of Clinical Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
chanlam_stephen@cuhk.edu.hk
Telephone: +852-2632-2118 Fax: +852-2648-7097
Received: March 29, 2016
Peer-review started: April 1, 2016
First decision: May 30, 2016
Revised: June 27, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: August 28, 2016
Processing time: 148 Days and 12.5 Hours
Portal vein tumor thrombosis (PVTT) is a common phenomenon in hepatocellular carcinoma (HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discuss the recent conceptual changes and summarize the data on the management of HCC with PVTT.
Core tip: Conventionally, the presence of portal vein tumor thrombosis (PVTT) indicated an extremely poor prognosis for hepatocellular carcinoma (HCC) patients and was considered a contraindication to both surgery and trans-arterial procedures. Recent studies indicate that HCC with PVTT represents a heterogeneous group with variable prognoses. Several classifications have been proposed to gauge the prognoses of PVTT. For selected patients with less severe PVTT, surgery with curative intent is feasible with favorable outcomes. Further, expanding treatment options, such as radiotherapy, radioembolization and systemic treatment, could improve the outcomes of patients with more severe forms of PVTT in patients with HCC.
