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

Abstract Recent developments in systemic chemotherapy for advanced hepatocellular carcinoma have been outstanding. However, reports on conversion surgery after lenvatinib therapy are scarce. We present the first case of advanced hepatocellular carcinoma with tumor thrombus in the suprahepatic vena cava close to the right atrium, which shrank after 12 weeks’ administration of lenvatinib, thereby leading to successful conversion surgery without using total vascular exclusion or extracorporeal circulation. The treatment strategy for hepatocellular carcinoma with macroscopic hepatic vein tumor thrombus is controversial, however, from a Japanese nationwide survey, surgical resection has been accepted as one of the treatment options for advanced hepatocellular carcinoma with hepatic vein tumor thrombus in Japan. However, the survival rate after resection of hepatocellular carcinoma having inferior vena cava tumor thrombus with extracorporeal circulation was reported to be worse than without extracorporeal circulation, and some preoperative down-sizing therapy for inferior vena cava tumor thrombus was advocated. Preoperative lenvatinib therapy might be a promising option among the multidisciplinary treatments for hepatocellular carcinoma with macroscopic tumor thrombus in the hepatic veins.

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Effectiveness of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Portal Vein and/or Inferior Vena Cava Tumor Thrombosis

PLoS ONE ◽

10.1371/journal.pone.0063864 ◽

2013 ◽

Vol 8 (5) ◽

pp. e63864 ◽

Cited By ~ 70

Author(s):

Mian Xi ◽

Li Zhang ◽

Lei Zhao ◽

Qiao-Qiao Li ◽

Su-Ping Guo ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Inferior Vena Cava ◽

Portal Vein ◽

Stereotactic Body Radiotherapy ◽

Inferior Vena ◽

Vena Cava ◽

Tumor Thrombosis

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A Case of Hepatocellular Carcinoma with Inferior Vena Cava Tumor Thrombosis Successfully Resected after Control of Ascites by Tolvaptan

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.80.551 ◽

2019 ◽

Vol 80 (3) ◽

pp. 551-557

Author(s):

Akihiko TAKAGI ◽

Noriyuki OBA ◽

Yusuke KYODEN ◽

Hideyuki KANEMOTO ◽

Makoto SUZUKI ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Tumor Thrombosis

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Nomogram for Predicting Long-Term Survival after Synchronous Resection for Hepatocellular Carcinoma and Inferior Vena Cava Tumor Thrombosis: A Multicenter Retrospective Study

Journal of Oncology ◽

10.1155/2020/3264079 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Yannan Bai ◽

Jiayi Wu ◽

Yong Zeng ◽

Jie Chen ◽

Shuangjia Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Cox Regression ◽

Predictive Accuracy ◽

Vena Cava ◽

Calibration Plot ◽

Curative Intent ◽

Term Survival ◽

Tumor Thrombosis

Background. Although surgery for hepatocellular carcinoma (HCC) complicated with inferior vena cava tumor thrombus (IVCTT) may improve survival for some patients, prognostic markers remain elusive because of its rarity. We constructed a prognostic nomogram which predicts individualized survival benefit of curative-intent surgery for HCC patients with IVCTT. Methods. According to abdominothoracic anatomy of inferior vena cava (IVC), IVCTT can be divided into 3 types: inferior diaphragmic (ID), superior diaphragmic (SD), and intracardiac type (IC). Data of 64 HCC patients with IVCTT who underwent curative-intent surgery between 2008 and 2015 in four centers in China were analyzed retrospectively. Univariate and multivariate Cox regression analyses were conducted to select variables for the construction of a prognostic nomogram. Predictive accuracy and discriminative ability were examined by concordance index (C-index) and calibration curve. Results. Of 64 patients in the IVCTT classification, 37 (57.8%) were classified as ID type, 15 (23.4%) as SD type, and 12 (18.8%) as IC type. The 1-, 2-, 3-, and 5-year disease-specific survival (DSS) rates for patients in ID, SD, and IC groups were 94.4%, 55.6%, 71.4%, and 30.0%; 27.8%, 21.4%, 7.1%, and 0%; and 8.3%, 0%, 0%, and 0%, respectively. Independent factors included in the nomogram were ECOG performance status, AFP level ≥ 400 μg/L, tumor size ≥ 10 cm, portal vein tumor thrombosis, and IVCTT classification. The C-index of the nomogram was 0.812 (95% CI 0.761–0.873). The calibration plot for DSS probability showed excellent agreement between the prediction by nomogram and actual observation. Conclusions. Curative-intent surgery should be carefully evaluated and suggested according to our novel IVCTT classification. We have developed a visual web-based nomogram model to predict oncological prognosis of curative-intent surgery for HCC patients with IVCTT.

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