Progress of therapeutic proceeding of liver transplantation in hepatocellular carcinoma with portal vein tumor thrombosis / 中华消化外科杂志

ABSTRACT

Hepatocellular carcinoma (hereinafter referred to as liver cancer) often invades portal vein system. Usually, 10%-40% of liver cancer patients present with portal vein tumor thrombosis (PVTT) at the time of diagnosis. In Europe and the United States, liver cancer combined with PVTT is defined as advanced stage, thus, systemic therapy is recommended for these patients according to most published guidelines. But, in Asian countries, liver cancer combined with PVTT is treated in a more positive way, since not all cases of liver cancer combined with PVTT are deemed as a contraindication of surgery. Up to now, no global consensus or standard guideline for liver cancer combined with PVTT has been reached yet. Liver transplantation (LT) serves as a curative therapeutic option for unresectable liver cancer, but liver cancer combined with PVTT has always been regarded as a contraindication for LT due to high tumor recurrence after LT. Meanwhile, liver cancer combined with PVTT is also deemed as a status of extra-hepatic metastasis. In practice, however, many patients with liver cancer combined with PVTT seek LT because other alternatives are not available or suitable. Finally, this part of patients successfully received LT. Moreover, emerging studies reveal that well-selected patients with liver cancer combined with PVTT could benefit from LT. Especially, compared to other alternatives, LT following successful downstaging treatment (such as. selective internal radiation therapy, external beam radiation therapy, estereotactic body radiation therapy, and/or transarterial chemoembolization), could bring survival benefit for patients with liver cancer combined with PVTT. The author concentrates on the issue whether patients with liver cancer combined with PVTT are candidates for LT, and reviews the PVTT diagnosis and classification, supporting evidence, and opposing evidence.