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Comprehensive review of hepatocellular carcinoma with portal vein tumor thrombus:State of art and future perspectives

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 221-227页

作者： Paschalis Gavriilidis Timothy M Pawlik Daniel Azoulay Department of Surgery Colchester General HospitalTurner RoadColchester CO45JLUK Department of Surgery The Ohio State Wexner Medical CenterJames Comprehensive Cancer CenterColumbusOHUSA Department of Hepato-Biliary and Liver Transplantation surgery Paul Brousse University HospitalParis-Saclay UniversityVillejuif 94800France

Background:Despite advances in the diagnosis of patients with hepatocellular carcinoma(HCC),70%-80%of patients are diagnosed with advanced stage disease.portal vein tumor thrombus(PVTT)is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated.Data sources:A systematic search of MEDLINE(PubMed),Embase,Cochrane Library and Database for Systematic Reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases until December 2022 was conducted using free text and MeSH terms:hepatocellular carcinoma,portal vein tumor thrombus,portal vein thrombosis,vascular invasion,liver and/or hepatic resection,liver transplantation,and systematic review.Results:Centers of surgical excellence have reported promising results related to the individualized surgical management of portal thrombus versus arterial chemoembolization or systemic chemotherapy.Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus,accurate identification of the subgroups of patients who may benefit from resection,as well as meticulous surgical technique.This review addressed five specific areas:(a)formation of PVTT;(b)classifications of PVTT;(c)controversies related to clinical guidelines;(d)surgical treatments versus non-surgical approaches;and(e)characterization of surgical techniques correlated with classifications of PVTT.Conclusions:Current evidence from Chinese and Japanese high-volume centers demonstrated that patients with HCC and associated PVTT can be managed with surgical resection with acceptable results.

关键词： Hepatectomy Liver surgery Liver neoplasms portal vein tumor thrombus

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Transcatheter arterial chemoembolization combined with PD-1 inhibitors and Lenvatinib for hepatocellular carcinoma with portal vein tumor thrombus

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World Journal of Gastroenterology 2024年第8期30卷 843-854页

作者： Hong-Xiao Wu Xiao-Yan Ding Ya-Wen Xu Ming-Hua Yu Xiao-Mi Li Na Deng Jing-Long Chen Cancer Center Beijing Ditan HospitalCapital Medical UniversityBeijing 100015China

BACKGROUND Hepatocellular carcinoma(HCC)patients complicated with portal vein tumor thrombus(PVTT)exhibit poor prognoses and treatment responses.AIM To investigate efficacies and safety of the combination of PD-1 inhibitor,transcatheter arterial chemoembolization(TACE)and Lenvatinib in HCC subjects comorbid with PVTT.METHODS From January 2019 to December 2020,HCC patients with PVTT types Ⅰ-Ⅳ were retrospectively enrolled at Beijing Ditan Hospital.They were distributed to either the PTL or TACE/Lenvatinib(TL)group.The median progression-free survival(mPFS)was set as the primary endpoint,while parameters like median overall survival,objective response rate,disease control rate(DCR),and toxicity level served as secondary endpoints.RESULTS Forty-one eligible patients were finally recruited for this study and divided into the PTL(n=18)and TL(n=23)groups.For a median follow-up of 21.8 months,the DCRs were 88.9%and 60.9%in the PTL and TL groups(P=0.046),res-pectively.Moreover,mPFS indicated significant improvement(HR=0.25;P<0.001)in PTL-treated patients(5.4 months)compared to TL-treated(2.7 months)patients.There were no treatment-related deaths or differences in adverse events in either group.CONCLUSION A triplet regimen of PTL was safe and well-tolerated as well as exhibited favorable efficacy over the TL regimen for advanced-stage HCC patients with PVTT types Ⅰ-Ⅳ.

关键词： Hepatocellular carcinoma Transcatheter arterial chemoembolization Lenvatinib PD-1 inhibitor portal vein tumor thrombus

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Treatments of Hepatocellular Carcinoma with portal vein tumor thrombus:Current Status and Controversy

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Journal of Clinical and Translational Hepatology 2022年第1期10卷 147-158页

作者： Zhu-Jian Deng Le Li Yu-Xian Teng Yu-Qi Zhang Yu-Xin Zhang Hao-Tian Liu Jian-Li Huang Zhen-Xiu Liu Liang Ma Jian-Hong Zhong Hepatobiliary Surgery Department Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterGuangxi Medical University Cancer HospitalNanningGuangxiChina

The proportions of patients with hepatocellular carcinoma(HCC)involving portal vein tumor thrombus(PVTT)varies greatly in different countries or regions,ranging from 13%to 45%.The treatment regimens for PVTT recommended by HCC guidelines in different countries or regions also vary greatly.In recent years,with the progress and development of surgical concepts,radiotherapy techniques,systematic therapies(for example,VEGF inhibitors,tyrosine kinase inhibitors and immune checkpoint inhibitors),patients with HCC involving PVTT have more treatment options and their prognoses have been significantly improved.To achieve the maximum benefit,both clinicians and patients need to think rationally about the indications of treatment modalities,the occurrence of severe adverse events,and the optimal fit for the population.In this review,we provide an update on the treatment modalities available for patients with HCC involving PVTT.Trials with large sample size for patients with advanced or unresectable HCC are also reviewed.

关键词： Hepatocellular carcinoma portal vein tumor thrombus Treatment modality

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CT guided ^125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma

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Chinese Medical Journal 2008年第23期121卷 2410-2414页

作者： ZHANG Fu-jun LI Chuan-xing JIAO De-chao ZHANG Nian-hua WU Pei-hong DUAN Guang-feng WU Yue-xia State Key Laboratory of Oncology in South China Department of Imaging and Interventional Radiology Cancer Centre Sun Yat-sen University Guangzhou Guangdong 510060 China Department of Oncology Guangdong Second Provincial Traditional Chinese Medicine Hospital Guangzhou Guangdong 510095 China

Background This study evaluated the clinical application of CT guided ^125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods The ten patients （9 males and 1 female, aged from 36 to 72 years） with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery, transcatheter arterial chemoembolization, radiotherapy ablation, microwave ablation or percutaneous ethanol injection. The average diameter of each tumor thrombus was 21.5 mm × 30.5 mm. Seeds of 30 MBq ^125I were implanted 5 mm apart within the portal vein tumor thrombus. The follow-up after 4 months included enhanced spiral CT. Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy, 5 partial response and 1 stable disease. Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase, which were controlled by medical management. Severe complications such as haemorrhage, biliary fistula hepatic abscess, pancreatic fistula and hepatic function failure were not observed. Implanted seeds migrated to lung and left hepatic lobe in 1 case. Conclusion CT guided implantation of ^125iodine seeds, can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.

关键词： ^125I iodine seed implantation portal vein tumor thrombus brachytherapy primary hepatocellular carcinoma

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Treatment of portal vein tumor thrombus using ^(125)Iodine seed implantation brachytherapy

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World Journal of Gastroenterology 2010年第38期16卷 4876-4879页

作者： Lin Zhang Wei Mu Cun-Fang Hu Xue-Quan Huang Department of Interventional Radiology Southwest Hospital Third Military Medical University Chongqing 400038China

We reported two cases of liver metastasis with portal vein tumor thrombus that developed after liver transplantation for hepato cellular carcinoma (HCC). Both the patients were women aged 43 and 55 years, who had liver metastasis and portal vein tumor thrombus formation after liver transplantations for HCC. For the treatment of portal vein tumor thrombus, 125I seeds were implanted into the hepatic tissue under the guidance of preoperative computed tomography (CT) images with a total radiation dose of 130 Gy. Enhanced spiral CT scan was performed for evaluation of the liver at 12 and 16 wk after treatment. Thereafter, upper abdominal CT examination was performed every 2-3 mo. No severe complications associated with the 125I seeds were seen in these two patients. The upper abdominal CT images (obtained after 3 and 4 mo of treatment) showed that the thrombosis reactions were complete reaction and restoration of the patency of the partially obstructed portal vein with partial obstruction. In the case with complete obstruction of the portal vein, the thrombosis was resolved completely, but blood flow could not be restored. After this treatment, one of the patients is stillalive, while the other died within 6 mo after the treatment due to lung metastasis complicated with lung infection, leading to respiratory failure.

关键词： Computed tomography-guided 125Iodine seed implantation brachytherapy Hepatocellular carcinoma 125I radioisotopes Brachytherapy portal vein tumor thrombus

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Hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus

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World Journal of Hepatology 2017年第36期9卷 1296-1304页

作者： Toshiya Kamiyama Tatsuhiko Kakisaka Tatsuya Orimo Kenji Wakayama Department of Gastroenterological SurgeryⅠ Graduate School of MedicineHokkaido UniversitySapporo 060-8638Japan

Despite surgical removal of tumors with portal vein tumor thrombus(PVTT) in hepatocellular carcinoma(HCC) patients, early recurrence tends to occur, and overall survival(OS) periods remain extremely short. The role that hepatectomy may play in long-term survival for HCC with PVTT has not been established. The operative mortality of hepatectomy for HCC with PVTT has also not been reviewed. Hence, we reviewed recent literature to assess these parameters. The OS of patients who received hepatectomy in conjunction with multidisciplinary treatment tended to be superior to that of patients who did not. Multidisciplinary treatments included the following: preoperative radiotherapy on PVTT; preoperative transarterial chemoembolization(TACE); subcutaneous administration of interferon-alpha(IFN-α) and intra-arterial infusion of 5-fluorouracil(5-FU) with infusion chemotherapy in the affected hepatic artery; cisplatin, doxorubicin and 5-FU locally administered in the portal vein; and subcutaneous injection of IFN-α, adjuvant chemotherapy(5-FU + Adriamycin) administration via the portal vein with postoperative TACE, percutaneous isolated hepatic perfusion and hepatic artery infusion and/or portal vein chemotherapy. The highest reported rate of operative mortality was 9.3%. In conclusion, hepatectomy for patients affected by HCC with PVTT is safe, has low mortality and might prolong survival in conjunction with multidisciplinary treatment.

关键词： Hepatocellular carcinoma portal vein tumor thrombus Hepatectomy Multidisciplinary treatment Operative mortality

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Liver transplantation for hepatocellular carcinoma in India: Are we ready for 2040?

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World Journal of Transplantation 2024年第1期14卷 141-153页

作者： Hirak Pahari Amruth Raj Ambreen Sawant Dipak S Ahire Raosaheb Rathod Chetan Rathi Tushar Sankalecha Sachin Palnitkar Vikram Raut Department of Liver Transplant and HPB Surgery Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Liver Transplant Anaesthesia Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210India Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsAurangabad 431003India Department of Gastroenterology and Hepatology Medicover HospitalsNashik 422009India Department of Gastroenterology and Hepatology Medicover HospitalsPune 411026India

BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established worldwide.The cornerstone of this treatment lies in the various criteria formulated by expert consensus and experience.The variations among the criteria are staggering,and the short-and long-term outcomes are controversial.AIM To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the future.METHODS We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were received.The centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was noted.RESULTS Of the 23 centers,35%were high volume center(>500 Liver transplants)while 52%were high-volume centers that performed more than 50 transplants/year.Approximately 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the patients.Barring a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC lesion.Positron-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied indications.The alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the criteria.The criteria for successful downstaging varied,but most centers conformed to the UCSF or

关键词： Hepatocellular carcinoma Liver transplant India Downstaging Survey Milan University of California,San Francisco portal vein tumor thrombus Expanded criteria

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Drug-eluting bead transarterial chemoembolization as neoadjuvant therapy pre-liver transplantation for advanced-stage hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2476-2486页

作者： Zhao-Dan Ye Li Zhuang Meng-Chen Song Zhe Yang Wu Zhang Jing-Feng Zhang Guo-Hong Cao Department of Radiology Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical CollegeHangzhou 310022Zhejiang ProvinceChina Department of Hepatobiliary and Pancreatic Surgery Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical CollegeHangzhou 310022Zhejiang ProvinceChina Diagnostic and Therapeutic Center for Difficult Diseases Hwa Mei HospitalUniversity of Chinese Academy of SciencesNingbo 315010Zhejiang ProvinceChina

BACKGROUND The objectives of this study were to assess the safety and efficacy of drug-eluting bead transarterial chemoembolization(DEB-TACE)as neoadjuvant therapy before liver transplantation(LT)for advanced-stage hepatocellular carcinoma(HCC)and to analyze the prognostic factors.AIM To determine whether DEB-TACE before LT is superior to LT for advanced-stage HCC.METHODS A total of 99 individuals diagnosed with advanced HCC were studied retrospectively.The participants were categorized into the following two groups based on whether they had received DEB-TACE before LT:DEB-TACE group(n=45)and control group(n=54).The participants were further divided into two subgroups based on the presence or absence of segmental portal vein tumor thrombus(PVTT).The DEB-TACE group consisted of two subgroups:Group A(n=31)without PVTT and group B(n=14)with PVTT.The control group also had two subgroups:Group C(n=37)without PVTT and group D(n=17)with PVTT.Data on patient demographics,disease characteristics,therapy response,and adverse events(AEs)were collected.The overall survival(OS)and recurrence-free survival(RFS)rates were assessed using Kaplan-Meier curves.Univariate and multivariate Cox regression analyses were conducted to determine the parameters that were independently related to OS and RFS.RESULTS The DEB-TACE group exhibited an overall response rate of 86.6%.Following therapy,there was a significant decrease in the median alpha-fetoprotein(AFP)level(275.1 ng/mL vs 41.7 ng/mL,P<0.001).The main AE was post-embolization syndrome.The 2-year rates of RFS and OS were significantly higher in the DEB-TACE group than in the control group(68.9%vs 38.9%,P=0.003;86.7%vs 63.0%,P=0.008).Within the subgroups,group A had higher 2-year rates of RFS and OS compared to group C(71.0%vs 45.9%,P=0.038;83.8%vs 62.2%,P=0.047).The 2-year RFS rate of group B was markedly superior to that of group D(64.3%vs 23.5%,P=0.002).Results from multivariate analyses showed that pre-LT DEB-TACE[hazard ratio(HR)=2.73,95%confidence interval(CI):1.44-5.14,P=0.04

关键词： Hepatocellular carcinoma Liver transplantation portal vein tumor thrombus Drug-eluting bead transarterial chemoembolization Neoadjuvant treatment

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Transarterial chemoembolization plus stent placement for hepatocellular carcinoma with main portal vein tumor thrombosis:A meta-analysis

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World Journal of Clinical Oncology 2024年第3期15卷 447-455页

作者： Wei-Fan Sui Jian-Yun Li Jian-Hua Fu Department of Interventional Radiology Zhenjiang First People's HospitalZhenjiang 212000Jiangsu ProvinceChina

BACKGROUND portal vein tumor thrombus is an important indicator of poor prognosis in patients with hepatocellular carcinoma.Transarterial chemoembolization is recommended as the standard first-line therapy for unresectable hepatocellular carcinoma.portal vein stent placement is a safe and effective therapy for promptly restoring flow and relieving portal hypertension caused by tumor thrombus.AIM To assess the clinical significance of transarterial chemoembolization plus stent placement for the treatment of hepatocellular carcinoma with main portal vein tumor thrombosis.METHODS We searched English and Chinese databases,assessed the quality of the included studies,analyzed the characteristic data,tested heterogeneity,explored heterogeneity,and tested publication bias.RESULTS In total,eight clinical controlled trials were included.The results showed that the pressure in the main portal vein after stent placement was significantly lower than that with no stent placement.The cumulative stent patency and survival rates at 6 and 12 months were lower in the transarterial chemoembolization+stent placement group than in the transarterial chemoembolization+stent placement+brachytherapy/radiotherapy group.The survival rates of patients treated with transarterial chemoembolization+stent placement for 6 and 12 months were higher than those of patients treated with transarterial chemoembolization alone.CONCLUSION For Chinese patients with hepatocellular carcinoma with main portal vein tumor thrombosis,transarterial chemoembolization plus stenting is effective.Transarterial chemoembolization+stent placement is more effective than transarterial chemoembolization alone.Transarterial chemoembolization+stent placement+brachytherapy/radiotherapy is more effective than transarterial chemoembolization+stenting.

关键词： Hepatocellular carcinoma Transarterial chemoembolization portal vein tumor thrombus Stent Meta-analysis

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CT-Guided 125iodine Seed Implantation for portal vein tumor thrombus in Primary Hepatocellular Carcinoma

CT-Guided 125iodine Seed Implantation for Portal Vein Tumor ...

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中国(第七届)肿瘤微创治疗学术大会暨世界影像导引下肿瘤...

作者： ZHANG Fu-jun,JIAO De-chao,Zhang Nian-hua,LI Chuan-xing,WU Pei-hong,DUAN Guang-feng,WU Yue-xia State Key Laboratory of Oncology in South China,Department of Imaging and Interventional Radiology,Cancer Center,Sun Yat-sen University,Guangzhou,510060,China(Zhang FJ,Jiao DC,Li CX,Wu PH,Duan GF,Wu YX) Department of Medical Oncology,Guangdong Second Provincial Traditional Chinese Medicine Hospital,Guangzhou,510095, China(Zhang NH)

＜正＞Background To investigate the clinical value of CT guided 125iodine seed implantation in treating portal vein tumor thrombus in primary hepatocellular carcinoma patients. Methods 10 patients（9 males and 1 females,median age 51 years,range from 36 to 72） with portal vein tumor thrombus with hepatocellular carcinoma accepted CT guided 125iodine seed implantation were enrolled in this study. The portal vein tumor thrombus were not well controlled by hepatocellular carcinoma combined therapy,such as surgery,transcatheter arterial chemoembolization（TACE）,radiotherapy ablation（RFA）,microwave ablation（MA）,or percutaneous ethanol injection（PEI）.The average diameter of each tumor thrombus was 2.1×2.8cm.Under the guidance of CT,125I seeds of 0.8mCi were implanted under local anesthesia at a distance of 0.5cm along portal vein tumor thrombus according to TPS.Enhanced spiral CT follow-up was performed 4 months post intervention. Results A total of 10 patients with portal vein tumor thrombus received CT-guided 125iodine seed implantation. The local control of the treated lesions was quite satisfactory with 4 months,and the overall response rate was 90.0% （9/10）,with observed complete response（CR） in 4 patients,partial response（PR） in 5 patients,and stable disease （SD） in 1 patient.The adverse effects mainly included aggravated abdominal dropsy and temporary increased hepatic aminopherase,which were controlled by medical management.Moreover,we have seen seeds migration to lung and left hepatic lobe in 1 case.No other complications such as hemorrhoea,cholo-fistulase,hepatic abscess,pancreatic fistula and hepatic function failure were encountered in all patients. Conclusions CT-guided 125iodine seed implantation was proved safety and effectiveness in the treatment of portal vein tumor thrombus with hepatocellular carcinoma with minimal damage and few complications.

关键词： 125iodine seed implantation portal vein tumor thrombus brachytherapy primary hepatocellular carcinoma

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