PVTT in HCC

Q: The finding of portal vein tumor thrombus(PVTT) in patients with Hepatocellular carcinoma (HCC) is a good prognostic sign as it signifies en masse total resectability?

A) True

B) False

Answer: B

PVTT is a macrovascular invasion in HCC and is a poor prognostic sign. It leads to major complications such as worsening liver function, metastatic disease, portal hypertension, and intolerance for treatment. It has been staged in five categories, Vp3 or Vp4 goes only for supportive care as survival is barely 8-16 weeks.

• Vp0 – No tumor thrombus in the portal vein;
• Vp1 – Segmental tumor thrombus distal to the second-order branches of the portal vein without direct involvement
• Vp2 – Invasion of a second order (right anterior or posterior, left anterior or posterior) branch of the portal vein
• Vp3 – Presence of the tumor thrombus in a first-order (right or left lobar) branch of the portal vein
• Vp4 – Tumor thrombus in the main trunk of the portal vein or a portal vein branch that is contralateral to the primarily involved lobe (or both)

#hepatology

#oncology

References:

1. Mähringer-Kunz A, Steinle V, Kloeckner R, et al. The impact of portal vein tumor thrombosis on survival in patients with hepatocellular carcinoma treated with different therapies: A cohort study. PLoS One 2021; 16:e0249426.

2. Khan AR, Wei X, Xu X. Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma - The Changing Tides. J Hepatocell Carcinoma 2021; 8:1089.

3. Mähringer-Kunz A, Steinle V, Düber C, et al. Extent of portal vein tumour thrombosis in patients with hepatocellular carcinoma: The more, the worse? Liver Int 2019; 39:324.