Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
Department of Bioimaging and Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
World J Gastroenterol. 2019 Aug 21;25(31):4360-4382. doi: 10.3748/wjg.v25.i31.4360.
Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide: Portal vein tumor thrombosis (PVTT) occurs in about 35%-50% of patients and represents a strong negative prognostic factor, due to the increased risk of tumor spread into the bloodstream, leading to a high recurrence risk. For this reason, it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care, due to its antiangiogenetic action, although it can grant only a poor prolongation of life expectancy. Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition, including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement, tumor biological aggressiveness, complications caused by portal hypertension, patient's clinical features and tolerance to antineoplastic treatments. The median survival has been reported to range between 2.7 and 4 mo in absence of therapy, but it can vary from 5 mo to 5 years, thus depicting an extremely variable scenario. For this reason, it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients.
门静脉癌栓（PVTT）发生在约 35%-50%的患者中，是一个强烈的预后不良因素，因为这增加了肿瘤扩散到血液中的风险，导致高复发风险。因此，它是肝移植的禁忌症，在几种预后评分中，索拉非尼是其标准治疗方法，因为它具有抗血管生成作用，尽管它只能延长预期寿命。最近的科学证据表明，PVTT 是一种复杂的解剖学和临床状况，包括不同预后的广泛患者和根据门静脉系统受累程度、肿瘤生物学侵袭性、门静脉高压引起的并发症、患者的临床特征和对抗肿瘤治疗的耐受性等因素的新治疗可能性。在没有治疗的情况下，中位生存期报告在 2.7 至 4 个月之间，但它可以从 5 个月到 5 年不等，因此描绘了一个极其多变的情况。因此，非常重要的是要关注最适合应用于每一组 PVTT 患者的策略。
