Progress of therapeutic proceeding of liver transplantation in hepatocellular carcinoma with portal vein tumor thrombosis
Hepatocellular carcinoma(hereinafter referred to as liver cancer)often invades portal vein system.Usually,10％-40％of liver cancer patients present with portal vein tumor throm-bosis(PVTT)at the time of diagnosis.In Europe and the United States,liver cancer combined with PVTT is defined as advanced stage,thus,systemic therapy is recommended for these patients accord-ing to most published guidelines.But,in Asian countries,liver cancer combined with PVTT is treated in a more positive way,since not all cases of liver cancer combined with PVTT are deemed as a con-traindication of surgery.Up to now,no global consensus or standard guideline for liver cancer com-bined with PVTT has been reached yet.Liver transplantation(LT)serves as a curative therapeutic option for unresectable liver cancer,but liver cancer combined with PVTT has always been regarded as a contraindication for LT due to high tumor recurrence after LT.Meanwhile,liver cancer combined with PVTT is also deemed as a status of extra-hepatic metastasis.In practice,however,many patients with liver cancer combined with PVTT seek LT because other alternatives are not available or suit-able.Finally,this part of patients successfully received LT.Moreover,emerging studies reveal that well-selected patients with liver cancer combined with PVTT could benefit from LT.Especially,com-pared to other alternatives,LT following successful downstaging treatment(such as.selective inter-nal radiation therapy,external beam radiation therapy,estereotactic body radiation therapy,and/or transarterial chemoembolization),could bring survival benefit for patients with liver cancer com-bined with PVTT.The author concentrates on the issue whether patients with liver cancer combined with PVTT are candidates for LT,and reviews the PVTT diagnosis and classification,supporting evi-dence,and opposing evidence.
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