Hepatocellular carcinoma with portal vein tumor thrombosis: deficiencies in the currently available classifications / 中华消化外科杂志

ABSTRACT

There are two international classifications for hepatocellular carcinoma with portal vein tumour thrombosis (HCC with PVTT)the Cheng's Classification and the Liver Cancer Study Group of Japan.These two classifications are quite similar.Personally Ⅰ prefer the Cheng's Classification for 2 reasons(1) it is not easy to differentiate Vpl and Vp2 in the Japanese Classification;and (2) the Japanese Classification does not have a stage for PVTT that extends to the superior mesenteric vein,i.e.the Cheng's Type Ⅳ.The main defect of these two classifications is that both classifications consider only the extent of PVTT without considering other factors which impact on treatment and prognosis.I apply some important prognostic factors used in the Barcelona Clinic Liver Cancer (BCLC) Classification for liver cancer onto the Cheng's Classification of HCC with PVTT,to come up with a new Lau-Cheng Classification.These factors include(1) the general condition of the patient,the liver functional status and whether there is any serious associated medical diseases;(2) extrahepatic metastasis;(3) main PVTT;(4) resectability of the primary liver cancer;(5) combination with microvascular invasion (MVI).This new classification divides HCC with PVTT into the very early stage (MVI only),early stage (resectable HCC with PVTT),intermediate stage (not resectable),late stage (wlth extrahepatic metastases),and terminal stage (poor general condition,decompensated liver function,or associated with serious medical diseases).The early,intermediate and late stages can further be divided into A and B according to whether the main portal vein is not involved or is involved by PVTT.All these different stages of HCC with PVTT have their own recommended treatment and prognosis.This new classification needs to be supported by clinical data before it can be used.