Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016

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 tr...

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Published inWorld journal of gastroenterology : WJG Vol. 22; no. 32; pp. 7289 - 7300
Main Authors Chan, Stephen L, Chong, Charing CN, Chan, Anthony WH, Poon, Darren MC, Chok, Kenneth SH
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 28.08.2016
Subjects
agent;Surgery;Radiotherapy
cancer;Vascular
Carcinoma, Hepatocellular - complications
Chemoembolization, Therapeutic
Combined Modality Therapy
Humans
invasion;Targeted
Liver
Liver Neoplasms - complications
Portal Vein - surgery
Review
Stents
Thrombectomy
Venous Thrombosis - classification
Venous Thrombosis - etiology
Venous Thrombosis - therapy
Vascular invasion
Liver cancer
Targeted agent
Radiotherapy
Surgery
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Summary: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 discussthe recent conceptual changes and summarize the data on the management of HCC with PVTT.
Bibliography:Stephen L Chan;Charing CN Chong;Anthony WH Chan;Darren MC Poon;Kenneth SH Chok;State Key Laboratory in Oncology of South China, Institute of Digestive Disease, The Chinese University of Hong Kong;Department of Clinical Oncology, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital;Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong;State Key Laborator in Oncology of South China, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong;Department of Surgery, Queen Mary Hospital, The University of Hong Kong
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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.
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
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v22.i32.7289