Treatment for hepatocellular carcinoma with tumor thrombosis in the hepatic vein or inferior vena cava: A comprehensive review

Abstract

Hepatocellular carcinoma (HCC) is the most common type of liver cancer with a high mortality rate worldwide. The percentage of HCC patients with vascular invasion is high. However, tumor thrombus in the hepatic vein (HVTT) has a lower incidence than tumor thrombus in the portal vein (PVTT). Conventionally, HCC patients with HVTT are treated the same as HCC patients with PVTT and offered sorafenib or other systemic agents. However, according to recent studies, it is evident that HCC with HVTT shows different outcomes when classified into different subgroups. In this review, we discuss the recent progress and changes in treatment of HCC with HVTT.

Keywords: Hepatocellular carcinoma; Vascular invasion; Surgery; Transarterial chemoembolization

Core Tip: Vascular invasion or tumor thrombus in hepatocellular carcinoma (HCC) patients is very common. Vascular invasion includes two different types, i.e., tumor thrombosis in the portal vein (PVTT) or hepatic vein (HVTT). Compared with PVTT, HVTT is found with a lower incidence. Most of published studies are concentrated on HCC with PVTT. Recent studies have proved magnificent prognostic results in HCC patients with HVTT. Several classifications have been proposed to gauge the prognoses of HVTT. Although further investigations are needed, expanding treatment options including hepatectomy, radiotherapy, radioembolization, and systemic treatment are reported to improve the outcomes of patients with HVTT.