Abstract
Hepatocellular carcinoma is the fourth leading cause of cancer-related morbidity and mortality in China. Portal vein tumor thrombus (PVTT) is common and it worsens prognosis of hepatocellular carcinoma (HCC). There is no internationally accepted consensus or guideline for diagnosis and treatment of HCC with PVTT. Based on existing evidences and common current practices, Chinese Experts on Multidisciplinary Diagnosis and Treatment of HCC with portal vein tumor thrombus met to develop a national consensus on diagnosis and treatment of HCC with PVTT. The meeting concluded with the First Edition (version 2016) of consensus statements with grades of evidence given as grades Ia, Ib, IIa, IIb, III and IV, and ranking as Classes A, B, C, D and I for quality of evidence and strength of recommendation by the United State Preventive Service Task Force, respectively. The consensus suggests recommended treatment to be based on patients PVTT type and ECOG functional status; surgery being the preferred treatment for Child-Pugh A, PVTT type I/II, and ECOG PS 0-1; transcatheter arterial chemoembolization (TACE) for non-resectable PVTT I/II and Child-Pugh A; and radiotherapy for non-resectable PVTT I/II/III and Child-Pugh A. Symptomatic treatment is recommended for Child-Pugh C, with massive ascites or gastrointestinal bleeding. By updating clinicians with treatment options for HCC with PVTT, the consensus statement aimed to prolong overall survival and to improve quality of life of patients with minimal treatment complication. Future treatment strategies for HCC with PVTT in China would depend on new evidences from more future clinical trials, especially studies defining the role of traditional Chinese medicine and clarifying molecular aspects of HCC.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide, and China accounts for more than half of new cases and deaths related to HCC every year [1]
The following are the recommendations for reducing recurrence rates and metastasis after surgery: (1) Preoperative small-dose radiotherapy has been reported to downstage some type III Portal vein tumor thrombus (PVTT) patients, reduce recurrence rate without increasing surgical risks, and reduce postoperative hepatic failure rates (Evidence level IIa) [26]
Sorafenib is recommended as the basic drug for PVTT patients (Evidence level Ib, Recommendation A)
Summary
Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide, and China accounts for more than half of new cases and deaths related to HCC every year [1]. In the study based on the findings of the Japanese registry, patients with type III/IV PVTT (extended to the main portal vein or the contralateral branch) and beyond had no significant improvement in survival after surgical treatment. The following are the recommendations for reducing recurrence rates and metastasis after surgery: (1) Preoperative small-dose radiotherapy has been reported to downstage some type III PVTT patients, reduce recurrence rate without increasing surgical risks, and reduce postoperative hepatic failure rates (Evidence level IIa) [26].
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