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Management of hepatocellular carcinoma patients with portal vein tumor thrombosis:A narrative review

Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 134-144页

作者： Zi-Wen Tao Bao-Quan Cheng Tao Zhou Yan-Jing Gao Department of Gastroenterology Qilu HospitalCheeloo College of MedicineShandong UniversityJinan 250012China

Background: Hepatocellular carcinoma(HCC) is one of the main reasons for malignancy-related death. portal vein tumor thrombosis(PVTT) is the most common form of macrovascular invasion related to HCC occurring in 10%-60% of patients. HCC with PVTT is usually characterized by worsening liver function, vulnerability to blood metastasis, higher incidence of complications associated with portal hypertension, and intolerance to treatment when compared with that without PVTT. If only treated with supportive care, the median survival of HCC with PVTT is about 2.7 months. In the past, sorafenib was the only recommended therapy by guidelines with limited effectiveness. This narrative review aimed to describe the current management options for HCC with PVTT. Data sources: We have reviewed literature from Pub Med on the treatment of HCC with PVTT and compiled evidence-based facts on effective therapies available for different types of PVTT. Results: Sorafenib monotherapy is not much effective, but combining it with other methods can improve survival. Each type of PVTT can beneft from the combination of transarterial chemoembolization and sorafenib than sorafenib monotherapy. The tumor downstaging can be realized possibly after transarterial chemoembolization, but tumor invasion into the main trunk of the portal vein greatly impairs efficacy. Although surgery is a curative approach, it is often not recommended for Vp4 PVTT. Some new methods can broaden the indication, but further explorations are needed. Radiotherapy can decrease the possibility of Vp3 progression to Vp4, but building a forecast model of best radiation dose and response is necessary. Systemic chemotherapy, hepatic arterial infusion chemotherapy, radiofrequency ablation, portal stenting, and traditional Chinese medicine are also benefcial in Vp3-4 PVTT. The accurate diagnosis of PVTT can be made by radiomics, and prognostic classifcation models can be used to design personalized treatments. The application of new

关键词： Hepatocellular carcinoma portal vein tumor thrombosis Transarterial chemoembolization Radiotherapy Surgery Sorafenib

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Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension

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World Journal of Gastrointestinal Surgery 2022年第6期14卷 567-579页

作者： Xuan-Hui Yan Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Yi-Fan Wu Ming-Ming Meng Ke Zhang Li Jiang Hui-Guo Ding Yue-Ning Zhang Yong-Ping Yang Fu-Quan Liu Department of Interventional Therapy Peking University Ninth School of Clinical MedicineBeijing Shijitan HospitalBeijing 100038China Department of Interventional Therapy Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Interventional Therapy Beijing Tongren HospitalCapital Medical UniversityBeijing 100005China Department of Gastroenterology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of General Surgery Beijing Ditan HospitalCapital Medical UniversityBeijing 100102China Department of Gastroenterology Beijing You'an HospitalCapital Medical UniversityBeijing 100069China Department of Liver Disease Digestion Center Beijing You'an HospitalCapital Medical UniversityBeijing 100069China Department of Liver Disease The Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China

BACKGROUND Patients with hepatocellular carcinoma complicated with main portal vein tumor thrombosis(mPVTT) and cirrhotic portal hypertension(CPH) have an extremely poor prognosis, and there is a lack of a clinically effective treatment *** To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)combined with radioactive seed strand for the treatment of mPVTT patients with *** The clinical data of 83 consecutive patients who underwent TIPS combined with 125I seed strand placement for mPVTT and CPH from January 2015 to December 2018 were retrospectively reviewed. Procedure-related data(success rate, relief of portal vein pressure and CPH symptoms,and adverse events), PVTT response, and patient survival were assessed through a 2-year *** The success rate was 100.0% without perioperative death or procedure-related severe adverse events. The mean portal vein pressure was significantly decreased after the procedure(22.25 ± 7.33mmHg vs 35.12 ± 7.94 mmHg, t = 20.61, P < 0.001). The symptoms of CPH were all effectively relieved within 1 mo. The objective response rate of PVTT was 67.5%. During a mean follow-up of 14.5 ± 9.4 mo(range 1-37 mo), the cumulative survival rates at 6, 12 and 24 mo were 83.1%, 49.7%,and 21.8%, respectively. The median survival time was 12.0 ± 1.3 mo(95% confidence interval: 9.5-14.5). In multivariate Cox regression analysis, body mass index, Child-Pugh grade, cTNM stage,and PVTT response were independent prognostic factors(P < 0.05).CONCLUSION TIPS combined with radioactive seed strand might be effective and safe in treating mPVTT patients with CPH.

关键词： Transjugular intrahepatic portosystemic shunt Radioactive seed strand portal vein tumor thrombosis Hepatocellular carcinoma Cirrhotic portal hypertension Cirrhosis

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Alpha-fetoprotein and 18F-FDG standard uptake value predict tumor recurrence after liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis:Preliminary experience

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Hepatobiliary & Pancreatic Diseases International 2020年第3期19卷 229-234页

作者： Zhe Yang Fang-Zhou Luo Shuo Wang Jan Lerut Li Zhuang Qi-Yong Li Xiao Xu Shu-Sen Zheng Department of Hepatobiliary and Pancreatic Surgery Department of Liver TransplantationShulan(Hangzhou)HospitalZhejiang Shuren University School of MedicineHangzhouChina Division of Hepatobiliary Pancreatic Surgery First Affiliated HospitalZhejiang University School of MedicineHangzhouChina National Clinical Research Center of Infectious Diseases HangzhouChina Starzl Unit of Abdominal Transplantation University Hospitals Saint LucUniversitécatholique LouvainBrusselsBelgium

Background:portal vein tumor thrombosis(PVTT)is regarded as a contraindication for liver transplantation(LT)in hepatocellular carcinoma(HCC).However,some of these patients may have a favorable prognosis after *** this study,we evaluated the biological behavior of HCC with PVTT using tumor biomarker(alpha-fetoprotein,AFP)and 18 F-FDG positron emission tomography(tumor standard uptake value)to identify a subset of patients who may be suitable for ***:Seventy-five HCC-PVTT liver recipients transplanted during February 2016 and June 2018 were *** pre-transplant prognostic factors were identified by univariate and multivariate *** status was identified following Vp classification(Vp1-Vp4).Results:Three-year recurrence-free survival and overall survival rates were 40%and 65.4%in Vp2-Vp3 PVTT patients,21.4%and 30.6%in Vp4 PVTT patients(Ptumor diameter>8 cm,pretransplant AFP level>1000 ng/m L and intrahepatic tumor maximal standard uptake value(SUVmaxtumor>5)were independent risk factors for HCC recurrence and overall survival after LT in Vp2-3 PVTT *** risk patients were defined as total tumor diameter≤8 cm;or if total tumor diameter more than 8 cm,with both pre-transplant AFP level less than 1000 ng/m L and intrahepatic tumor SUVmax less than 5,***-two Vp2-3 PVTT HCC patients(46.8%)were identified as low risk patients,and their 3-year recurrence-free and overall survival rates were 67.6%and 95.2%,***:Patients with segmental or lobar PVTT and biologically favorable tumors defined by AFP and 18 F-FDG SUVmax might be suitable for LT.

关键词： Hepatocellular carcinoma Liver transplantation portal vein tumor thrombosis Alpha-fetoprotein Standard uptake value

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Risk factors of poor prognosis and portal vein tumor thrombosis after curative resection of solitary hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2013年第1期12卷 68-73页

作者： Li Zhou Jing-An Rui Shao-Bin Wang Shu-Guang Chen Qiang Qu Department of General Surgery Peking Union Medical College HospitalChinese Academy of Medical Sciences/Peking Union Medical College

BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still ***,risk factors for portal vein tumor thrombosis(PVTT) in SHCC are *** present study was designed to address this ***:Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni-and multi-variate ***:Univariate analysis showed that PVTT,tumornode-metastasis(TNM) stage,Edmondson-Steiner grade and preoperative serum alpha-fetoprotein(AFP) level were associated with the overall and disease-free survival,whereas tumor size only influenced the overall *** multivariate Cox regression tests,Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and diseasefree *** addition,the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with *** them,only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression ***,AFP,the sole preoperative factor for PVTT,was not adequately sensitive and ***:Factors relating to post-surgical prognosis and PVTT in SHCC are all *** these,EdmondsonSteiner grade and TNM stage might be of particular importance in survival *** addition,accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult.

关键词： solitary hepatocellular carcinoma curative resection prognosis portal vein tumor thrombosis

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Factors influencing the short-term and long-term survival of hepatocellular carcinoma patients with portal vein tumor thrombosis who underwent chemoembolization

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World Journal of Gastroenterology 2021年第13期27卷 1330-1340页

作者： Ke-Li Chen Jian Gao Department of Gastroenterology and Hepatology The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010China

BACKGROUND The factors affecting the short-term and long-term prognosis of hepatocellular carcinoma(HCC) patients with portal vein tumor thrombosis(PVTT) receiving transarterial chemoembolization(TACE) are still *** To clarify the predictors correlated with the short-term and long-term survival of HCC patients with PVTT who underwent *** The medical records of 181 HCC patients with PVTT who underwent TACE at the Second Affiliated Hospital of Chongqing Medical University from January 2015 to July 2019 were retrospectively analyzed. We explored the short-term and longterm prognostic factors by comparing the preoperative indicators of patients who died and survived within 3 mo and 12 mo after TACE. Multivariate analyses were conducted using logistic regression. The area under the receiver operating characteristic curve(area under curve) was used to evaluate the predictive ability of the factors related to the short-term and long-term *** The median survival time was 4.8 mo(range: 2.5-8.85 mo). The 3 mo, 6 mo, and 12 mo survival rates were 68.5%, 38.7%, and 15.5%, respectively. In multivariable analysis, total bilirubin, sex, and aspartate aminotransferase(AST) were closely linked to short-term survival. When AST ≥ 87 U/L and total bilirubin ≥ 16.15 μmol/L, the 3-mo survival rate after TACE was reduced significantly(P tumors and the gross pathological type of tumor are

关键词： Transarterial chemoembolization Hepatocellular carcinoma portal vein tumor thrombosis Survival Prognostic factors

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Percutaneous transhepatic intraportal biopsy using gastroscope biopsy forceps for diagnosis of a pancreatic neuroendocrine neoplasm:A case report

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World Journal of Gastroenterology 2023年第7期29卷 1235-1242页

作者： Guang-Chuan Wang Guang-Jun Huang Chun-Qing Zhang Qian Ding Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021Shandong ProvinceChina

BACKGROUND Pancreatic neuroendocrine neoplasms(PNENs)are a rare group of neoplasms originating from the islets of the *** vein tumor thrombosis has been reported in 33%of patients with *** the histopathological diagnosis of PNENs is usually based on percutaneous biopsy or endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA),these approaches may be impeded by gastric varices,poor access windows,or anatomically contiguous critical *** a pathological diagnosis using a gastroscope biopsy forceps via percutaneous transhepatic intravascular pathway is an innovative method that has rarely been *** SUMMARY A 72-year-old man was referred to our hospital for abdominal pain and *** contrast-enhanced magnetic resonance imaging revealed a wellenhanced tumor(size:2.4 cm×1.2 cm×1.2 cm)in the pancreatic tail with portal vein *** pathological diagnosis via EUS-FNA was not possible because of diffuse gastric *** performed a percutaneous transportal biopsy of the portal vein tumor thrombus using a gastroscope biopsy *** examination revealed a pancreatic neuroendocrine neoplasm(G2)with somatostatin receptors 2(+),allowing systemic *** Intravascular biopsy using gastroscope biopsy forceps appears to be a safe and effective method for obtaining a histopathological *** welldesigned clinic trials are required to obtain more definitive evidence,this procedure may help improve the diagnosis of portal vein thrombosis and related diseases.

关键词： Percutaneous transhepatic intravascular biopsy portal vein tumor thrombosis Gastroscope biopsy forceps Pancreatic neuroendocrine neoplasms Case report

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Triplet regimen as a novel modality for advanced unresectable hepatocellular carcinoma:A case report and review of literature

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世界临床病例杂志 2023年第27期11卷 6558-6564页

作者： Ying Zhao Guo-Sheng He Gong Li Department of Radiation Oncology Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China

BACKGROUND portal vein tumor thrombus(PVTT)is a common complication,accounting for 44%-62.2%of Hepatocellular carcinoma(HCC),and often indicates the poor *** is no global consensus for the treatment of unresectable HCC with *** the present case,we reported a novel strategy of radiotherapyantiangiogenesis-immune checkpoint blockade combination,which showed better response and prolonged *** SUMMARY A 51-year-old male diagnosed with HCC(Child-Pugh class A),chronic hepatitis B virus infection and Cheng’s type III PVTT,was given radiotherapy to part of the lesion plus targeted therapy as the first-line therapy,and achieved partial *** radiotherapy,lenvatinib plus pembrolizumab was used as maintenance therapy,and complete remission was *** patient remains alive 46 months after the diagnosis of the HCC with *** This case of unresectable HCC patient with PVTT treated by radiation-lenvatinibpembrolizumab combination therapy shows apparent clinical efficacy,which demonstrates that local radiotherapy plus antiangiogenesis and immune checkpoint blockad could also benefit patients with advanced HCC.

关键词： Hepatocellular carcinoma portal vein tumor thrombosis Radiotherapy Combination therapy RACIB Case report

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Neoadjuvant radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus:a systematic review

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Hepatobiliary Surgery and Nutrition 2022年第5期11卷 709-717页

作者： Zhewen Wei Jianjun Zhao Xinyu Bi Yefan Zhang Jianguo Zhou Zhiyu Li Zhen Huang Hong Zhao Jianqiang Cai Department of Hepatobiliary Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

Background:The prognosis of hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)is extremely *** clinical outcome of preoperative radiotherapy(RT)is still *** study aimed to compare the clinical outcomes of combined neoadjuvant RT and hepatectomy with hepatectomy alone for HCC with ***:Comprehensive database searches were performed in PubMed,the Cochrane Library,EMBASE,and the Web of Science to retrieve studies published from the database creation to July 1,*** comparative studies that measured survival between neoadjuvant RT followed by hepatectomy and hepatectomy alone were *** characteristics of the included studies and patients were extracted,and the included data are presented as relative ratio(RR)estimates with 95%confidence intervals(CIs)for all *** RRs of each study were pooled using a fixed or random effects model with Review Manager(the Cochrane Collaboration,Oxford,UK)version *** response rate to RT and the overall survival(OS)rate in neoadjuvant RT followed by hepatectomy and hepatectomy alone were ***:One randomized and two non-randomized controlled trials with 302 patients were *** patients were classified as Child-Pugh A,and Type II and III PVTT were the most common *** RT,29(22.8%)patients were evaluated as partial response(PR)and had a positive RT response,but nine(7.1%)had progressive disease(PD).Neoadjuvant RT followed by hepatectomy was received by 127(42.1%)patients after excluding 15(5.0%)patients with severe complications or PD after RT,and 160(53.0%)patients received hepatectomy *** the randomized controlled trial(RCT),the 1-year OS rate in the neoadjuvant RT group and the surgery alone group was 75.2%and 43.1%,respectively(P<0.001).In the two non-randomized studies,a meta-analysis with a fixed effects model showed a longer OS in patients undergoing neoadjuvant RT followed by hepatectomy compared with hepatectomy alone at 1-year follow-u

关键词： Hepatocellular carcinoma(HCC) portal vein tumor thrombosis neoadjuvant radiotherapy hepatectomy

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New Evidence and Perspectives on the Management of Hepatocellular Carcinoma with portal vein tumor Thrombus

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Journal of Clinical and Translational Hepatology 2017年第2期5卷 169-176页

作者： Jun Yin Wen-Tao Bo Jian Sun Xiao Xiang Jin-Yi Lang Jian-Hong zhong Le-Qun Li Department of Radiation Oncology Sichuan Cancer Hospital & Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China Department of Hepatobiliary Surgery Sichuan Cancer Hospital &Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China Department of Medical Affairs ZiBo Hospital of Integrated Traditional Chinese and Western Medicine Zibo China Department of Hepatobiliary Surgery Affiliated Tumor Hospital of Guangxi Medical University Nanning China

portal vein tumor thrombosis (PVTT) is an intractable condition but common phenomenon in hepatocellular carcinoma (HCC).HCC patients with PVTT may have worse liver function,a higher chance of comorbidity related to portal hypertension,lower tolerance to treatment and poorer *** Western guidelines,patients are offered palliative treatment with sorafenib or other systemic agents because HCC with PVTT is grouped together with metastatic HCC during the planning of its *** recent years,various treatment options have become available for patients with HCC and *** has also shifted toward evidencebased ***,policies for the management of HCC with PVTT have not been *** comprehensive literature review aims to present current and available management options for patients with HCC and *** is mainly based on studies published after 2010.

关键词： Hepatic resection Hepatocellular carcinoma portal vein tumor thrombosis Transarterial chemoembolization

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Stratification of portal vein-invaded hepatocellular carcinoma treated with transarterial chemoembolization monotherapy

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Journal of Interventional Medicine 2020年第4期3卷 201-207页

作者： Lei Zhang BinYan Zhong Bo Hu Wei Li Peng Huang Shen Zhang JinJin Song JianSong Ji CaiFang Ni Department of Interventional Radiology The First Affiliated Hospital of Soochow UniversitySuzhouChina Department of Interventional Radiology Zhejiang University Lishui HospitalThe Fifth Affiliated Hospital of Wenzhou Medical UniversityLishui Central HospitalLishuiChina

Purpose:The study aimed to establish a prognostic prediction model and an artificial neural network(ANN)model to determine who will benefit from transarterial chemoembolization(TACE)monotherapy for patients with hepatocellular carcinoma(HCC)invading portal ***:Treatment-naive patients with HCC and portal vein invasion who were treated with TACE monotherapy at hospital A as training cohort and hospital B as validation cohort were *** primary endpoint was overall survival(OS).In training cohort,independent risk factors associated with OS were identified by univariate and multivariate *** prognostic prediction(PP)and ANN models based on the independent risk factors were established to find out who will benefit most from TACE *** type of portal vein tumor thrombosis was classified based on the Cheng’s *** accuracy of the models was validated in validation ***:Totally,242 patients(training cohort:n=159;validation cohort:n=83)were *** median OS was 7.1 and 8.5 months in training and validation cohort,*** training cohort,the PP model was established based on the following five independent risk factors:Cheng’s Classification,Eastern Cooperative Oncology Group score,maximum tumor size,number of HCC nodules,and Child-Pugh *** score of 17.5 was identified as cut-off point and patients were divided into two groups by PP score17.5 in survival benefit and prognostication(8.8 vs.5.5 months;Pportal vein invaded HCC patients with PP score<17.5 may benefit most from TACE *** these patients,TACE monotherapy should be considered.

关键词： Hepatocellular carcinoma Transarterial chemoembolization portal vein tumor thrombosis Prognostic Artificial neural network

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