Liver Transplantation after Down‐staging of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus using Y‐90 Radioembolization: Pipe Dream or Reality?

2021 ◽  
Author(s):  
Neil Mehta ◽  
Francis Y. Yao
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Portal Vein Tumor Thrombus ◽  
Pipe Dream

scholarly journals Response To Pretransplant Downstaging Therapy Predicts Patient Outcome After Liver Transplantation For Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

2020 ◽  
Author(s):  
Zhe Yang ◽  
Shuo Wang ◽  
Jingqi Sun ◽  
Li Zhuang ◽  
Qiyong Li ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Overall Survival ◽  
Portal Vein ◽  
Tumor Necrosis ◽  
Tumor Thrombus ◽  
Poor Response ◽  
Portal Vein Tumor Thrombus ◽  
Tumor Viability

Abstract Background: Tumor viability and areas of necrosis after pretransplant downstaging therapy is predictive of patient outcome, but has not been evaluated in hepatocellular carcinoma (HCC) recipients with portal vein tumor thrombus (PVTT). Methods: Recurrence-free survival (RFS) and overall survival (OS) were compared among PVTT-HCC patients receiving pretransplant downstaging therapy with and without well response (radiographic tumor necrosis >50%). Multivariable predictors of well response to downstaging were identified.Results: Of 107 patients, downstaging was attempted in 48, and 15 had well response to pretransplant therapy. Compared with poor response and non-downstaged patients, well response patients had significantly superior 1-, 2-, and 3-year RFS (72%, 72%, and 72% vs 30.4%, 22.6%, and 22.6%; P = 0.002) and OS (100%, 90.9%, and 90.9% vs 66.3%, 47.7%, and 47.7%; P = 0.008). Pre-transplant alpha-fetoprotein (AFP) level <1000ng/mL and radiographic tumor necrosis >50% were independent favorable factors for lower HCC recurrence rate and better overall survival after liver transplantation (LT). Multivariable predictors of well response to downstage included well-moderate differentiated tumor on explant and multiple combined pretransplant locoregional and systematic therapies. Conclusions: For HCC patients with PVTT and receive pretransplant downstaging therapy, achieving well response is predictive of significantly better posttransplant outcomes and patients can have acceptable survival with LT after successful downstaging. Combined locoregional and systematic therapies may help to improve the responsiveness to downstaging.

S100P as a novel biomarker of microvascular invasion and portal vein tumor thrombus in hepatocellular carcinoma

2021 ◽  
Vol 15 (1) ◽  
pp. 114-126
Author(s):  
Lu-Nan Qi ◽  
Liang Ma ◽  
Fei-Xiang Wu ◽  
Yuan-Yuan Chen ◽  
Wan-Ting Xing ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Microvascular Invasion ◽  
Portal Vein Tumor Thrombus
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