Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Table 1 Outcome of transarterial chemoembolization in patients with hepatocellular carcinoma and different portal vein tumor thrombosis grades

First author, year	Patients (patients)	Treatment	PVTT Class (Vp)	Median survival time(mo)	1-yr survival rate	2-yr survival rate	3-yr survival rate	5-yr survival rate
Okazaki M, 1991	163	TACE	Vp 2 (48) Vp 3 (56) Vp 4 (59)	4.3 mo 4 mo 3.8 mo	-	-	-	-
Chung JW, 1995	83	TACE	Vp 3,4 (83)	6 mo	30%	18%	9%	-
Georgiades CS, 2005	32	TACE	Vp 3,4 (32)	9.5 mo	25%	-	-	-
Luo J, 2011	84	TACE	Vp 1,2 (40) Vp 3 (44)	10.2 mo 5.3 mo	30.9% 3.8%	9.2% 0%	-	-
Niu ZJ, 2012	115	TACE	Vp 1 (12) Vp 2 (52) Vp 3 (42) Vp 4 (9)	19 11 7.1 4	27.8%	6%	-	-
Peng ZW, 2012	402	TACE	Vp 1 (54) Vp 2 (136) Vp 3 (166) Vp 4 (46)	-	41.1% 37.9% 36.1% 30.4%	-	8.9% 6% 4.2% 4.3%	3.6% 0% 0% 0%
Ajit Y, 2014		TACE		6.2 mo	-	22%	-	-
Liu L, 2014	188	TACE	Vp 1,2 (98) Vp 3 (90)	6	38%	17%	3%	-
Liu PH, 2014	181	TACE	Vp 1,2 (181)	-	60%	-	42%	33%
Chern MC, 2014	50	TACE	Vp 1,2,3,4	6.2 mo (range, 1.7–50.9 mo)	22%	10%	8%	-
Tawada A, 2014	81	TACE	Vp 1,2,3,4	NA	45%	23%	20%	-
Ye JZ, 2014	338	TACE (86 patients)	Vp 1,2,3,4	7.0 mo	17.5%	0%	0%	-
Tan X, 2015	116	TACE (64 patients) TACE+PVE (52 patients)	Type I, II, III (according to Shi et al)	27.7 mo	60.9% 80.7%	41% 59%	25% 36.5%	0% 11.5%

Table 2 Main studies on the outcome of radiotherapy alone or combined with other treatments in patients with hepatocellular carcinoma and different portal vein tumor thrombosis grades

First author, year	Patients (patients)	Treatment	PVTT Class (Vp)	Response rate	Survival rate(yr)	Mean survival time(mo)
Tazawa, 2001	24	RT (50 Gy)+TACE	Vp3,4	50%	NA	9.7 mo
Yamada, 2001	8	RT (30 Gy)	Vp3	37.5%	NA	NA
Ishikura, 2002	20	TACE+RT (50 Gy)	Vp3	50%	25% (1-yr)	5.3 mo
Yamada K, 2003	19	TACE and 3D-RT (30Gy)	Vp3	57.9%	40.6%(1-yr), 10.2% (2-yr)	7 mo
Nakagawa, 2005	52	3D-CRT (39-60 Gy)	Vp2,3,4	NA	5.1% (5-yr)	NA
Kim DY, 2005	59	3D-CRT (39-70.2 Gy)	Vp3,4	45.8%	20.7% (2-yr)	10.7 mo
Hata, 2005	12	Proton-beam therapy (50-72 Gy)	Vp3,4	100%	88% (2-yr) 58% (5-yr)	27 mo
Lin CS, 2006	43	3D-CRT (21patients) Conventional Rtp (22 patients)	Vp3,4	83% 75%	NA NA	6.7 mo 6.0 mo
Hsu WC, 2006	53	3D-CRT+thalidomide	Vp3,4	50%	84.8% (6mo), 60.0% (1-yr), 44.6% (2-yr)	24.0 mo
Nakazawa, 2007	32	RT	Vp3-4, Vv2-3	48%	38.0% (1-yr), 20.7% (2-yr)	10.0 mo
Toya, 2007	38	3D-CRT (23.4-59.5 Gy)	Vp NA	44.7%	39.4% (1-yr)	9.6 mo (OS)
Shirai, 2009	26	3D-CRT using SPECT	Vp3,4	30.7%	30% (2-yr)	10.3 mo
Kang, 2013	101	RT+TACE TACE+RT	Vp NA	70.3%	A) 58.8% (1-yr), 29.4% (2-yr) B) 54.1% (1-yr), 27.0% (2-yr)	17 mo 15 mo
Nakazawa, 2014	97	3D-CRT (30-56 Gy)	Vp3,4	45%	NA	10.9 mo
Lee, 2014	46	3D-CRT (35-60 Gy)	Vp3,4	32.6%	66.8% (1-yr)	NA

3D-CRT: Conformal radiotherapy; Gy: Gray; NA: Not available; PVE: Portal vein embolization; PVTT: Portal vein tumor thrombosis; RT: Radiotherapy; SPECT: single photon emission computed tomography; TACE: Transarterial chemoembolization.

Table 3 Selected studies concerning the outcome of resective surgery in patients with hepatocellular carcinoma and different portal vein tumor thrombosis grades

First author, year	Patients (patients)	PVTT Class (Vp)	Mortality	5-yr survival rate	Median survival time (mo)
Yamaoka, 1992	29	3-4	11%	11.6% (3-yr)	NA
Ikai, 1998	26	3 4	NA	11% 4%	NA
Ohkubo, 2000	47	2-3-4	0%	23.9%	14 mo
Wu, 2000	97 15	1-2-3 4	3.1% 0%	28.5% 26.4%	NA NA
Poon, 2003	20	3-4, Vv2	5.7%	13.3%	6.0 mo
Ikai et al, 2004 (21,711 patients treated from 1989 to 1999)	17,867 1609 672 679	0 1 2 3-4	NA	56.5% 34.4% 27.0% 17.3%	NA
Pawlik, 2005	102	3, Vv 2-3	5.9%	10%	11 mo
Ikai, 2006	78	3-4	3.8%	10.9%	8.9 mo
Chen, 2007	286 152	1-3 4	NA 2.6%	18.1% 0%	10.1 mo
Le Treut, 2006	26	3-4, Vv2-3	11.5%	13%	9.0 mo
Zhou, 2006	381	2-3-4	NA	12%	NA
Shi, 2011	144 189 86 22	1 2 3 4	NA	26.7% (3-yr) 16.9% (3-yr) 3.7% (3-yr) 0% (3-yr)	NA
Inoue et al. 2009	20	4	0%	39.0%	NA
Ban, 2009	45	3 4	0% 0%	41.8% 20.9	20.0 mo
Kondo, 2009	5	4	0%	0%	8.0 mo
Ikai et al 2010 (25,066 patients treated from 1994 to 2005)	20,195 1978 820 1,021	0 1 2 3-4	NA	59.0% 39.1% 23.3% 18.3%	NA
Shi, 2010	169 78	3 4	0.6% 0%	17.7% (3-yr) 3.6% (3-yr)	15.0 mo 10.0 mo
Wang, 2013	25	Vv3	0%	13.5%	NA
Chok, 2013	88	1-2-3-4	3.3%	11.2-14.3%	NA
Pesi, 2015	15 5 21 8 3	1 2 3 Vv2 Vv3	NA	53.3% 30.1% 20.0% NA NA	NA
Xu, 2015	16 40	A B	100% NA	0% 5.2%	NA
Kokudo, 2016	1772 1475 1942 1285	1 2 3 4	NA	NA	2.67 yr 1.51 yr 0.78 yr 0.50 yr
Kudo, 2016	1908 714 852	1 2 3-4	NA	48.2% 29.2% 25.05	NA

NA: Not available; PVTT: Portal vein tumor thrombosis.