Abstract
Purpose
Hepatocellular carcinoma is a heterogenous group of disease with a spectrum of disease presentations that developed on the setting of liver cirrhosis, although the achievements made in the imaging techniques have enabled the early diagnosis in nearly 60% of the cases in cirrhotic patients. However, hepatobiliary centers and tertiary liver transplant centers have to treat patients with advanced hepatocellular carcinoma with portal venous tumor thrombosis.
Methods
In this review, liver transplantation results in hepatocellular carcinoma patients with portal vein tumor thrombosis is reviewed.
Results
Although historically portal venous tumor thrombosis is considered a contraindication for radical surgical procedures such as liver transplantation, current data suggests that patients with hepatocellular carcinoma and macrovascular invasion can achieve favorable outcomes with liver transplantation provided that strict selection criteria is applied. One of the cornerstones of treatment of these patients is development of locoregional therapy such as transarterial chemo and radioembolizations. Transarterial radioembolization is effective in patients if the pretreatment liver failure is mild and the tumor burden including extension to the portal vein is low. Although data is lacking especially radioembolization could even help physicians to differentiate tumors with favorable biologic characteristics.
Conclusions
Therefore, these patients should be subject of multimodality treatment, and liver transplantation should be offered whenever objective and significant response is obtained by locoregional therapies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of Data and Material
Not applicable.
Abbreviations
- AFP:
-
Alpha-feto-protein
- HCC:
-
Hepatocellular carcinoma
- LDLT:
-
Living donor liver transplantation
- LT:
-
Liver transplantation
- PIVKA-II:
-
Protein induced by vitamin k absence/antagonist-II
- PVTT:
-
Portal vein tumor thrombosis
- SBRT:
-
Stereotactic body radiotherapy
- TACE:
-
Transarterial chemoembolization
- TARE:
-
Transarterial radioembolization
References
Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet, vol. 379, Elsevier; 2012, p. 1245–55. https://doi.org/10.1016/S0140-6736(11)61347-0.
Cerrito L, Annicchiarico BE, Iezzi R, Gasbarrini A, Pompili M, Ponziani FR. Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: beyond the known frontiers. World J Gastroenterol. 2019;25:4360–82. https://doi.org/10.3748/wjg.v25.i31.4360.
Choi HJ, Kim DG, Na GH, Hong TH, Bae SH, You YK, et al. The clinical outcomes of patients with portal vein tumor thrombi after living donor liver transplantation. Liver Transpl. 2017;23:1023–31. https://doi.org/10.1002/lt.24782.
Ikai I, Arii S, Okazaki M, Okita K, Omata M, Kojiro M, et al. Report of the 17th nationwide follow-up survey of primary liver cancer in Japan. Hepatol Res. 2007;37:676–91. https://doi.org/10.1111/j.1872-034X.2007.00119.x.
Xu X, Zheng SS, Liang TB, Wang WL, Jin J, Shen Y, et al. Orthotopic liver transplantation for patients with hepatocellular carcinoma complicated by portal vein tumor thrombi. Hepatobiliary Pancreat Dis Int. 2004;3:341–4.
Spinzi G, Paggi S. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:2497–9. https://doi.org/10.1056/NEJMc081780.
Bruix J, Raoul JL, Sherman M, Mazzaferro V, Bolondi L, Craxi A, et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol. 2012;57:821–9. https://doi.org/10.1016/j.jhep.2012.06.014.
Lee K-W, Yi N-J, Suh K-S. Section 5. Further expanding the criteria for HCC in living donor liver transplantation: when not to transplant: SNUH experience. Transplantation. 2014;97(Suppl 8):S20–3. https://doi.org/10.1097/01.tp.0000446269.20934.d3.
Suh K-S, Lee HW. Liver transplantation for advanced hepatocellular carcinoma: how far can we go? Hepatic Oncol. 2015;2:19–28. https://doi.org/10.2217/hep.14.34.
Lee HW, Suh KS. Liver transplantation for advanced hepatocellular carcinoma. Clin Mol Hepatol. 2016;22:309–18. https://doi.org/10.3350/cmh.2016.0042.
Lee HW, Suh KS. Expansion of the criteria for living donor liver transplantation for hepatocellular carcinoma. Curr Opin Organ Transplant. 2016;21:231–7. https://doi.org/10.1097/MOT.0000000000000294.
Lee KW, Suh SW, Choi YR, Jeong J, Yi NJ, Kim H, et al. Macrovascular invasion is not an absolute contraindication for living donor liver transplantation. Liver Transpl. 2017;23:19–27. https://doi.org/10.1002/lt.24610.
Soin AS, Bhangui P, Kataria T, Baijal SS, Piplani T, Gautam D, et al. Experience with LDLT in patients with hepatocellular carcinoma and portal vein tumor thrombosis postdownstaging. Transplantation. 2020;Publish Ah. https://doi.org/10.1097/TP.0000000000003162.
Jeong Y, Shin MH, Yoon SM, Song GW, Kim KH, Ahn CS, et al. Liver transplantation after transarterial chemoembolization and radiotherapy for hepatocellular carcinoma with vascular invasion. J Gastrointest Surg. 2017;21:275–83. https://doi.org/10.1007/s11605-016-3302-0.
Salem R, Gordon AC, Mouli S, Hickey R, Kallini J, Gabr A, et al. Y90 radioembolization significantly prolongs time to progression compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2016;151:1155–1163.e2. https://doi.org/10.1053/j.gastro.2016.08.029.
Levi Sandri GB, Ettorre GM, Giannelli V, Colasanti M, Sciuto R, Pizzi G, et al. Trans-arterial radio-embolization: a new chance for patients with hepatocellular cancer to access liver transplantation, a world review. Transl Gastroenterol Hepatol. 2017;2:98–98. https://doi.org/10.21037/tgh.2017.11.11.
Spreafico C, Sposito C, Vaiani M, Cascella T, Bhoori S, Morosi C, et al. Development of a prognostic score to predict response to Yttrium-90 radioembolization for hepatocellular carcinoma with portal vein invasion. J Hepatol. 2018;68:724–32. https://doi.org/10.1016/j.jhep.2017.12.026.
Han DH, Joo DJ, Kim MS, Choi GH, Choi JS, Park YN, et al. Living donor liver transplantation for advanced hepatocellular carcinoma with portal vein tumor thrombosis after concurrent chemoradiation therapy. Yonsei Med J. 2016;57:1276–81. https://doi.org/10.3349/ymj.2016.57.5.1276.
Choi JY, Yu JI, Park HC, David Kwon CH, Kim JM, Joh JW, et al. The possibility of radiotherapy as downstaging to living donor liver transplantation for hepatocellular carcinoma with portal vein tumor thrombus. Liver Transpl. 2017;23:545–51. https://doi.org/10.1002/lt.24729.
Author information
Authors and Affiliations
Contributions
All authors contributed equally to the manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Code Availability
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Aydin, C., Yilmaz, S. Is Macroscopic Portal Vein Tumor Thrombosis of HCC Really an Exclusion for Liver Transplantation?. J Gastrointest Canc 51, 1137–1140 (2020). https://doi.org/10.1007/s12029-020-00488-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12029-020-00488-8