Quirk Matthew, Kim Yun Hwan, Saab Sammy, Lee Edward Wolfgang
Matthew Quirk, Edward Wolfgang Lee, Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-743730, United States.
World J Gastroenterol. 2015 Mar 28;21(12):3462-71. doi: 10.3748/wjg.v21.i12.3462.
Management of hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) is complex and requires an understanding of multiple therapeutic options. PVT is present in 10%-40% of HCC at the time of diagnosis, and is an adverse prognostic factor. Management options are limited, as transplantation is generally contraindicated, and surgical resection is only rarely performed in select centers. Systemic medical therapy with sorafenib has been shown to modestly prolong survival. Transarterial chemoembolization has been performed in select cases but has shown a high incidence of complications. Emerging data on treatment of PVT with Y-90 radioembolization suggest that this modality is well-tolerated and associated with favorable overall survival. Current society guidelines do not yet specifically recommend radioembolization for patients with PVT, but this may change with the development of newer staging systems and treatment algorithms. In this comprehensive literature review, we present current and available management options with the relative advantages, disadvantages and contraindications of these treatment options with summarized data on overall survival.
肝细胞癌（HCC）合并门静脉血栓形成（PVT）的管理较为复杂，需要了解多种治疗选择。在诊断时，10%-40%的HCC患者存在PVT，这是一个不良预后因素。由于通常禁忌进行移植，且仅在少数特定中心很少进行手术切除，因此管理选择有限。索拉非尼全身药物治疗已被证明可适度延长生存期。在某些病例中已进行经动脉化疗栓塞，但并发症发生率较高。关于用钇-90放射性栓塞治疗PVT的新数据表明，这种治疗方式耐受性良好且总体生存期良好。目前的学会指南尚未特别推荐对PVT患者进行放射性栓塞，但随着更新的分期系统和治疗算法的发展，这种情况可能会改变。在这篇全面的文献综述中，我们介绍了当前可用的管理选择，以及这些治疗选择的相对优势、劣势和禁忌证，并总结了总体生存期数据。
