Li ZY, Xie C, Cai HQ. Pre-transplant downstaging strategies for hepatocellular carcinoma with portal vein tumor thrombus: Current therapies and future challenges. World J Hepatol 2025; 17(11): 110614 [DOI: 10.4254/wjh.v17.i11.110614]
Corresponding Author of This Article
Hong-Qiao Cai, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. hongqiaocai@jlu.edu.cn
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Gastroenterology & Hepatology
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Minireviews
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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/
Nov 27, 2025 (publication date) through Dec 5, 2025
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World Journal of Hepatology
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1948-5182
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Li ZY, Xie C, Cai HQ. Pre-transplant downstaging strategies for hepatocellular carcinoma with portal vein tumor thrombus: Current therapies and future challenges. World J Hepatol 2025; 17(11): 110614 [DOI: 10.4254/wjh.v17.i11.110614]
World J Hepatol. Nov 27, 2025; 17(11): 110614 Published online Nov 27, 2025. doi: 10.4254/wjh.v17.i11.110614
Pre-transplant downstaging strategies for hepatocellular carcinoma with portal vein tumor thrombus: Current therapies and future challenges
Zong-Yang Li, Cheng Xie, Hong-Qiao Cai
Zong-Yang Li, Cheng Xie, Hong-Qiao Cai, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Cai HQ designed the overall concept and outline of the manuscript; Li ZY contributed to the discussion and design of the manuscript; Xie C contributed to the writing, and editing the manuscript, illustrations, and review of literature.
Conflict-of-interest statement: The authors have claimed no conflicts.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Qiao Cai, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. hongqiaocai@jlu.edu.cn
Received: June 12, 2025 Revised: July 14, 2025 Accepted: September 28, 2025 Published online: November 27, 2025 Processing time: 169 Days and 3.4 Hours
Abstract
Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide, with approximately 35%-50% of patients presenting concurrent portal vein tumor thrombus (PVTT). Untreated HCC patients with PVTT have a median survival of only 2.5-4 months, posing significant challenges to liver transplantation outcomes. Downstaging therapies play a pivotal role in improving transplant eligibility rates and optimizing post-transplant outcomes. This systematic review summarizes current downstaging therapies, including transarterial chemoembolization, transarterial radioembolization, proton beam therapy, intraportal radiofrequency ablation, and other novel systemic modalities. In-depth analysis of their clinical applications, efficacy, and safety profiles were performed. Furthermore, the review critically evaluates future challenges, including optimized downstaging criteria, personalized and precision medicine approaches, and novel biomaterials for localized therapy for downstaged HCC patients. This review provides comprehensive theoretical and practical insights into pre-transplant downstaging for HCC with PVTT, while highlighting critical avenues for future research and clinical decision-making.
Core Tip: Hepatocellular carcinoma with portal vein tumor thrombus has long been considered a contraindication for liver transplantation due to poor prognosis. However, evolving downstaging strategies, including transarterial chemoembolization, transarterial radioembolization, proton beam therapy, and combination immunotherapies, have shown potential to convert select patients into transplant candidates. This review summarizes current clinical evidence and highlights future directions involving personalized medicine, novel biomaterials, and standardized criteria.
