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(31): 4360-4382 [PMID: 31496618 DOI: 10.3748/wjg.v25.i31.4360]
Corresponding Author of This Article
Francesca Romana Ponziani, MD, PhD, Doctor, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome 00168, Italy. francesca.ponziani@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 21, 2019; 25(31): 4360-4382 Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4360
Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers
Lucia Cerrito, Brigida Eleonora Annicchiarico, Roberto Iezzi, Antonio Gasbarrini, Maurizio Pompili, Francesca Romana Ponziani
Lucia Cerrito, Brigida Eleonora Annicchiarico, Antonio Gasbarrini, Maurizio Pompili, Francesca Romana Ponziani, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Roberto Iezzi, Department of Bioimaging and Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Author contributions: Cerrito L, Pompili M and Ponziani FR were responsible for manuscript preparation, table design, reference collection and final editing; Annicchiarico BE, Iezzi R and Gasbarrini A contributed to this paper with drafting and critical revision and editing.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Francesca Romana Ponziani, MD, PhD, Doctor, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome 00168, Italy. francesca.ponziani@gmail.com
Telephone: +39-347-1227242
Received: April 22, 2019 Peer-review started: April 22, 2019 First decision: June 10, 2019 Revised: June 24, 2019 Accepted: July 19, 2019 Article in press: July 19, 2019 Published online: August 21, 2019
Abstract
Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide: Portal vein tumor thrombosis (PVTT) occurs in about 35%-50% of patients and represents a strong negative prognostic factor, due to the increased risk of tumor spread into the bloodstream, leading to a high recurrence risk. For this reason, it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care, due to its antiangiogenetic action, although it can grant only a poor prolongation of life expectancy. Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition, including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement, tumor biological aggressiveness, complications caused by portal hypertension, patient’s clinical features and tolerance to antineoplastic treatments. The median survival has been reported to range between 2.7 and 4 mo in absence of therapy, but it can vary from 5 mo to 5 years, thus depicting an extremely variable scenario. For this reason, it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients.
Core tip: Portal vein tumor thrombosis (PVTT) is a complex anatomical and clinical condition, including patients with different prognosis according to the degree of portal system involvement, tumor biological aggressiveness, complications caused by portal hypertension, patient’s clinical features and tolerance to antineoplastic treatments. For this reason, it is extremely important to focus on the most adequate treatment strategy for each group of PVTT patients.
