Among patients with hepatocellular carcinoma (HCC) who develop portal vein tumor thrombosis (PVTT), alternative treatment modalities to systemic therapy may yield optimal survival outcomes, according to research published in PLoS One.

In the presence of PVTT, HCC has a greatly reduced prognosis. PVTT incidence in this population is up to 40%, and presentation with PVTT is, by Barcelona Clinic Liver Cancer Classification, a criterion for considering HCC advanced disease. This classification has received endorsement from both the European Association for the Study of the Liver and the American Association of the Study of Liver Diseases.

Guidelines suggest that patients with HCC presenting with PVTT receive palliative systemic treatment, irrespective of the extremity of PVTT. The standard of care includes sorafenib, although patients will frequently receive alternative, individualized therapies per clinician decision.

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An important problem in this patient population, however, is whether these alternative therapies yield similar outcomes to the standard of care. For this cohort study, researchers evaluated whether, considering the extent of patient PVTT, some patients might benefit from other treatments than the standard of care systemic therapy.

PVTT extent was categorized, following the Liver Cancer study group of Japan, in the following way: Vp1 indicated segmental PV invasion, Vp2 indicated right anterior or posterior PV, Vp3 indicated right or left PV, and Vp4 indicated main trunk PV.

Data from 278 patients with previously untreated HCC and PVTT were included in the present analysis. All patients were treated between 2005 and 2016.

In the Vp1 group (45 patients; 16.2%), resection, transarterial chemoembolization/selective internal radiation therapy, sorafenib, and best supportive care had median overall survival (OS) periods of 32.4, 8.1, unknown, and 1.7 months, respectively; in the Vp2 group (54 patients; 19.4%), 10.7, 6.9, 5.5, and 1.2 months, respectively; in the Vp3 group (89 patients; 32%), 6.6, 7.5, 2.9, and 0.6 months, respectively; in the Vp4 group (90 patients; 32.4%), 8.0, 3.6, 5.3, and 0.7 months, respectively (all P < .01).

The authors noted the analysis indicated that patients in the Vp1 group who underwent resection had a significantly longer median OS than that seen with other treatment modalities, indicating the current standard of care is not always the best option.

“These findings suggest that for well-selected patients with minor PVTT, resection may be an appropriate alternative therapeutic option when deemed oncologically reasonable,” the authors wrote.


Mähringer-Kunz A, Steinle V, Kloeckner R, et al. The impact of portal vein tumor thrombosis on survival in patients with hepatocellular carcinoma treated with different therapies: A cohort study. PLoS One. 2021;16(5):e0249426. doi:10.1371/journal.pone.0249426