The Progress of Treatment for Primary Liver Cancer with Portal Vein Tumor Thrombus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIAO Kaiyin , PENG Minhao

Department of Hepatobiliary Surgery， The First Affiliated Hospital of Guangxi Medical University， Nanning 530021， Guangxi Zhuang Autonomous Region， China;

Corresponding author：

Keywords：

Primary liver cancer; Portal vein tumor thrombus; Treatment

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Objective 　To improve the prognosis of primary liver cancer with portal vein tumor thrombus （PVTT）， the progress of treatment for primary liver cancer with PVTT was reviewed.
Methods 　The therapeutic approach and its efficacy for primary liver cancer with PVTT were summarized by literature search within recent years.
Results 　PVTT is a common complication of primary liver cancer， the therapeutic approach are surgical resection， transcatheter arterial chemoembolization (TACE), intraportal venous therapy， radiotherapy， ablation therapy, molecular targeted therapy， etc. The excision rate for primary liver cancer with PVTT is low， the treatment is difficult and the outcome is dismal. It remains a poor prognosis at present， and the therapeutic effect need to be promoted.
Conclusions　 The main treatment for primary liver cancer with PVTT should be surgical excision combine with other multidisciplinary comprehensive treatment to improve the survival in patients with PVTT， moreover， the therapeutic approach should be individualized and sequentially according to the patient’s condition and the type of PVTT.

Citation： XIAO Kaiyin,PENG Minhao,.. The Progress of Treatment for Primary Liver Cancer with Portal Vein Tumor Thrombus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(3): 259-265. doi: Copy

1.	Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carci noma with portal vein tumor thrombosis： clinical characteristics,prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007,52(11)：3290-3295.
2.	Cedrone A， Rapaccini GL， Pompili M， et al. Portal vein thrombosis complicating hepatocellular carcinoma. Value of ultrasoundguided fine-needle biopsy of the thrombus in the therapeutic management [J]. Liver， 1996， 16(2)： 94-98.
3.	陆婉玲，党亚正. 原发性肝癌并门静脉癌栓的研究现状 [J].西北国防医学杂志， 2009， 30(2)：129-131.
4.	Cabibbo G， Enea M， Attanasio M， et al. A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma [J]. Hepatology， 2010， 51(4)： 1274-1283.
5.	Lau WY， Lai EC， Yu SC. Management of prtal vein tumor thrombus// Wy L ed Hepatocellular carcinoma [M]. Singapore：World Sientific Publishing Co， Pte. Ltd， 2008： 1-24.
6.	Kondo K， Chijiiwa K， Kai M， et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors [J]. J Gastrointest Surg， 2009， 13(6)：1078-1083.
7.	Lin DX， Zhang QY， Li X， et al. An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus [J]. J Cancer Res Clin Oncol， 2011,137(1)： 139-149.
8.	Shuqun C， Mengchao W， Han C， et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein [J]. Hepatogastroenterology, 2007,54(74)： 499-502.
9.	Shi J, Lai E, Li N, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus [J]. Ann Surg Oncol,2010， 17(8)： 2073-2080.
10.	Yoshidome H， Takeuchi D， Kimura F， et al. Treatment strategy for hepatocellular carcinoma with major portal vein or inferior vena cava invasion： a single institution experience [J]. J Am Coll Surg， 2011， 212(5)： 796-803.
11.	Shi J， Lai EC， Li N， et al. A new classification for hepatocellular carcinoma with portal vein tumor thrombus [J]. J Hepatobiliary Pancreat Sci， 2011, 18(1)： 74-80.
12.	Ban D， Shimada K， Yamamoto Y， et al. Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein [J]. J Gastrointest Surg， 2009， 13(11)： 1921-1928.
13.	Yamaoka Y， Kumada K， Ino K， et al. Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein [J]. World J Surg， 1992， 16(6)： 1172-1176.
14.	Inoue Y， Hasegawa K， Ishizawa T， et al. Is there any difference in survival according to the portal tumor thrombectomy method in patients with hepatocellular carcinoma? [J]. Surgery， 2009,145(1)： 9-19.
15.	郑虹，高伟，朱志军，等. 肝移植治疗肝细胞癌合并门静脉癌栓的疗效评价 [J]. 中华器官移植杂志， 2009， 30(8)：484-486.
16.	Georgiades CS， Hong K， D’angelo M， et al. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2005， 16(12)： 1653-1659.
17.	Carr BI， Irish W， Federle MP， et al. Chemoembolization for unresectable hepatocellular carcinoma in patients with or without portal vein thrombosis [J]. Hepatogastroenterology， 2010，57(104)： 1375-1381.
18.	Luo J， Guo RP， Lai EC， et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis： a prospective comparative study [J]. Ann Surg Oncol，2011， 18(2)： 413-420.
19.	刘德鑫，李新丰，李华东，等. 肝动脉栓塞化疗对肝癌并门静脉癌栓疗效观察 [J]. 中国基层医药， 2010， 17(2)：158-159.
20.	Schwarz RE， Abou-Alfa GK，Geschwind JF， et al. Nonoperative therapies for combined modality treatment of hepatocellular cancer： expert consensus statement [J]. HPB (Oxford)， 2010，12(5)： 313–320.
21.	Kim JH， Yoon HK， Kim SY， et al. Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis [J]. Aliment Pharmacol Ther， 2009， 29(12)： 1291-1298.
22.	Chen LW， Chien RN， Fang KM， et al. Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis [J]. Hepatogastroenterology， 2010， 57(98)：228-231.
23.	Ikeda M， Okusaka T， Ueno H， et al. Hepatic arterial infusion chemotherapy with epirubicin in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis [J]. Oncology,2007， 72(3-4)： 188-193.
24.	Tsai AL， Burke CT， Kennedy AS， et al. Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2010， 21(9)：1377-1384.
25.	Luo J， Yan Z， Liu Q， et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein [J]. J Vasc Interv Radiol， 2011， 22(4)： 479-489.
26.	Liang LJ， Hu WJ， Yin XY， et al. Adjuvant intraportal venous chemotherapy for patients with hepatocellular carcinoma and portal vein tumor thrombi following hepatectomy plus portal thrombectomy [J]. World J Surg， 2008， 32(4)： 627-631.
27.	张跃伟，娜仁图戈，高飞，等. 经皮肝穿刺注射碘油化疗药物治疗原发性肝癌门静脉癌栓的临床研究 [J]. 中国介入影像与治疗学， 2009， 6(2)：167-169.
28.	Marelli L， Shusang V， Buscombe JR， et al. Transarterial injection of (131) I-lipiodol, compared with chemoembolization， in the treatment of unresectable hepatocellular cancer [J]. J Nucl Med,中国普外基础与临床杂志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 265 ?2009， 50(6)： 871-877.
29.	Zhang FJ， Li CX， Jiao DC， et al. CT guided 125Iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma [J]. Chin Med J (Engl)， 2008， 121(23)： 2410-2414.
30.	Zhang XB， Wang JH， Yan ZP， et al. Hepatocellular carcinoma with main portal vein tumor thrombus： treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization [J]. Cancer， 2009， 115(6)： 1245-1252.
31.	Kamiyama T， Nakanishi K， Yokoo H， et al. Efficacy of preoperative radiotherapy to portal vein tumor thrombus in the main trunk or first branch in patients with hepatocellular carcinoma [J]. Int J Clin Oncol， 2007， 12(5)： 363-368.
32.	Sugahara S， Nakayama H， Fukuda K， et al. Proton-beam therapy for hepatocellular carcinoma associated with portal vein tumor thrombosis [J]. Strahlenther Onkol， 2009， 185(12)： 782-788.
33.	Yamamoto K， Masuzawa M， Kato M， et al. Evaluation of combined therapy with chemoembolization and ethanol injection for advanced hepatocellular carcinoma [J]. Semin Oncol， 1997， 24 (2 Suppl 6)： S6-50-S6-55.
34.	王守华，嵇雪琴，李咏梅. 无水酒精注射术治疗门静脉癌栓25例 [J]. 现代肿瘤医学， 2011， 19(2)：326-327.
35.	Hirooka M， Koizumi Y， Kisaka Y， et al. Mass reduction by radiofrequency ablation before hepatic arterial infusion chemotherapy improved prognosis for patients with huge hepatocellular carcinoma and portal vein thrombus [J]. AJR Am J Roentgenol,2010， 194(2)： W221-W226.
36.	Giorgio A， Di Sarno A， de Stefano G， et al. Hepatocellular carcinoma with cirrhosis： are patients with neoplastic main portal vein invasion eligible for percutaneous radiofrequency ablation of both the nodule and the portal venous tumor thrombus? [J]. AJR Am J Roentgenol， 2009， 193(4)： 948-954.
37.	Lu ZH， Shen F， Yan ZL， et al. Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation [J]. J Cancer Res Clin Oncol， 2009， 135(6)： 783-789.
38.	党亚正，张学成，陆婉玲，等. 体部伽玛刀与高强度聚焦超声治疗原发性肝癌门静脉癌栓的临床观察 [J]. 现代肿瘤医学，2010， 18(1)：114-117.
39.	Irtan S， Chopin-Laly X， Ronot M， et al. Complete regression of locally advanced hepatocellular carcinoma induced by sorafenib allowing curative resection [J]. Liver Int， 2011， 31(5)： 740-743.
40.	Ishizaki M， Kaibori M， Matsui K， et al. The effect of sorafenib and intermittent hepatic arterial infusion chemotherapy using cisplatin for advanced hepatocellular carcinoma with portal vein tumor thrombus—a pilot study [J]. Gan To Kagaku Ryoho， 2010,37(12)： 2679-2682.
41.	Peng BG， He Q， Li JP， et al. Adjuvant transcatheter arterial chemoembolization improves efficacy of hepatectomy for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Surg， 2009， 198(3)： 313-318.

1. Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carci noma with portal vein tumor thrombosis： clinical characteristics,prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007,52(11)：3290-3295.
2. Cedrone A， Rapaccini GL， Pompili M， et al. Portal vein thrombosis complicating hepatocellular carcinoma. Value of ultrasoundguided fine-needle biopsy of the thrombus in the therapeutic management [J]. Liver， 1996， 16(2)： 94-98.
3. 陆婉玲，党亚正. 原发性肝癌并门静脉癌栓的研究现状 [J].西北国防医学杂志， 2009， 30(2)：129-131.
4. Cabibbo G， Enea M， Attanasio M， et al. A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma [J]. Hepatology， 2010， 51(4)： 1274-1283.
5. Lau WY， Lai EC， Yu SC. Management of prtal vein tumor thrombus// Wy L ed Hepatocellular carcinoma [M]. Singapore：World Sientific Publishing Co， Pte. Ltd， 2008： 1-24.
6. Kondo K， Chijiiwa K， Kai M， et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors [J]. J Gastrointest Surg， 2009， 13(6)：1078-1083.
7. Lin DX， Zhang QY， Li X， et al. An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus [J]. J Cancer Res Clin Oncol， 2011,137(1)： 139-149.
8. Shuqun C， Mengchao W， Han C， et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein [J]. Hepatogastroenterology, 2007,54(74)： 499-502.
9. Shi J, Lai E, Li N, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus [J]. Ann Surg Oncol,2010， 17(8)： 2073-2080.
10. Yoshidome H， Takeuchi D， Kimura F， et al. Treatment strategy for hepatocellular carcinoma with major portal vein or inferior vena cava invasion： a single institution experience [J]. J Am Coll Surg， 2011， 212(5)： 796-803.
11. Shi J， Lai EC， Li N， et al. A new classification for hepatocellular carcinoma with portal vein tumor thrombus [J]. J Hepatobiliary Pancreat Sci， 2011, 18(1)： 74-80.
12. Ban D， Shimada K， Yamamoto Y， et al. Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein [J]. J Gastrointest Surg， 2009， 13(11)： 1921-1928.
13. Yamaoka Y， Kumada K， Ino K， et al. Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein [J]. World J Surg， 1992， 16(6)： 1172-1176.
14. Inoue Y， Hasegawa K， Ishizawa T， et al. Is there any difference in survival according to the portal tumor thrombectomy method in patients with hepatocellular carcinoma? [J]. Surgery， 2009,145(1)： 9-19.
15. 郑虹，高伟，朱志军，等. 肝移植治疗肝细胞癌合并门静脉癌栓的疗效评价 [J]. 中华器官移植杂志， 2009， 30(8)：484-486.
16. Georgiades CS， Hong K， D’angelo M， et al. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2005， 16(12)： 1653-1659.
17. Carr BI， Irish W， Federle MP， et al. Chemoembolization for unresectable hepatocellular carcinoma in patients with or without portal vein thrombosis [J]. Hepatogastroenterology， 2010，57(104)： 1375-1381.
18. Luo J， Guo RP， Lai EC， et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis： a prospective comparative study [J]. Ann Surg Oncol，2011， 18(2)： 413-420.
19. 刘德鑫，李新丰，李华东，等. 肝动脉栓塞化疗对肝癌并门静脉癌栓疗效观察 [J]. 中国基层医药， 2010， 17(2)：158-159.
20. Schwarz RE， Abou-Alfa GK，Geschwind JF， et al. Nonoperative therapies for combined modality treatment of hepatocellular cancer： expert consensus statement [J]. HPB (Oxford)， 2010，12(5)： 313–320.
21. Kim JH， Yoon HK， Kim SY， et al. Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis [J]. Aliment Pharmacol Ther， 2009， 29(12)： 1291-1298.
22. Chen LW， Chien RN， Fang KM， et al. Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis [J]. Hepatogastroenterology， 2010， 57(98)：228-231.
23. Ikeda M， Okusaka T， Ueno H， et al. Hepatic arterial infusion chemotherapy with epirubicin in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis [J]. Oncology,2007， 72(3-4)： 188-193.
24. Tsai AL， Burke CT， Kennedy AS， et al. Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2010， 21(9)：1377-1384.
25. Luo J， Yan Z， Liu Q， et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein [J]. J Vasc Interv Radiol， 2011， 22(4)： 479-489.
26. Liang LJ， Hu WJ， Yin XY， et al. Adjuvant intraportal venous chemotherapy for patients with hepatocellular carcinoma and portal vein tumor thrombi following hepatectomy plus portal thrombectomy [J]. World J Surg， 2008， 32(4)： 627-631.
27. 张跃伟，娜仁图戈，高飞，等. 经皮肝穿刺注射碘油化疗药物治疗原发性肝癌门静脉癌栓的临床研究 [J]. 中国介入影像与治疗学， 2009， 6(2)：167-169.
28. Marelli L， Shusang V， Buscombe JR， et al. Transarterial injection of (131) I-lipiodol, compared with chemoembolization， in the treatment of unresectable hepatocellular cancer [J]. J Nucl Med,中国普外基础与临床杂志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 265 ?2009， 50(6)： 871-877.
29. Zhang FJ， Li CX， Jiao DC， et al. CT guided 125Iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma [J]. Chin Med J (Engl)， 2008， 121(23)： 2410-2414.
30. Zhang XB， Wang JH， Yan ZP， et al. Hepatocellular carcinoma with main portal vein tumor thrombus： treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization [J]. Cancer， 2009， 115(6)： 1245-1252.
31. Kamiyama T， Nakanishi K， Yokoo H， et al. Efficacy of preoperative radiotherapy to portal vein tumor thrombus in the main trunk or first branch in patients with hepatocellular carcinoma [J]. Int J Clin Oncol， 2007， 12(5)： 363-368.
32. Sugahara S， Nakayama H， Fukuda K， et al. Proton-beam therapy for hepatocellular carcinoma associated with portal vein tumor thrombosis [J]. Strahlenther Onkol， 2009， 185(12)： 782-788.
33. Yamamoto K， Masuzawa M， Kato M， et al. Evaluation of combined therapy with chemoembolization and ethanol injection for advanced hepatocellular carcinoma [J]. Semin Oncol， 1997， 24 (2 Suppl 6)： S6-50-S6-55.
34. 王守华，嵇雪琴，李咏梅. 无水酒精注射术治疗门静脉癌栓25例 [J]. 现代肿瘤医学， 2011， 19(2)：326-327.
35. Hirooka M， Koizumi Y， Kisaka Y， et al. Mass reduction by radiofrequency ablation before hepatic arterial infusion chemotherapy improved prognosis for patients with huge hepatocellular carcinoma and portal vein thrombus [J]. AJR Am J Roentgenol,2010， 194(2)： W221-W226.
36. Giorgio A， Di Sarno A， de Stefano G， et al. Hepatocellular carcinoma with cirrhosis： are patients with neoplastic main portal vein invasion eligible for percutaneous radiofrequency ablation of both the nodule and the portal venous tumor thrombus? [J]. AJR Am J Roentgenol， 2009， 193(4)： 948-954.
37. Lu ZH， Shen F， Yan ZL， et al. Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation [J]. J Cancer Res Clin Oncol， 2009， 135(6)： 783-789.
38. 党亚正，张学成，陆婉玲，等. 体部伽玛刀与高强度聚焦超声治疗原发性肝癌门静脉癌栓的临床观察 [J]. 现代肿瘤医学，2010， 18(1)：114-117.
39. Irtan S， Chopin-Laly X， Ronot M， et al. Complete regression of locally advanced hepatocellular carcinoma induced by sorafenib allowing curative resection [J]. Liver Int， 2011， 31(5)： 740-743.
40. Ishizaki M， Kaibori M， Matsui K， et al. The effect of sorafenib and intermittent hepatic arterial infusion chemotherapy using cisplatin for advanced hepatocellular carcinoma with portal vein tumor thrombus—a pilot study [J]. Gan To Kagaku Ryoho， 2010,37(12)： 2679-2682.
41. Peng BG， He Q， Li JP， et al. Adjuvant transcatheter arterial chemoembolization improves efficacy of hepatectomy for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Surg， 2009， 198(3)： 313-318.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Progress of Treatment for Primary Liver Cancer with Portal Vein Tumor Thrombus

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