Current Diagnosis and Treatment for Hepatocellular Carcinoma with Macrovascular Tumor Thrombosis

Macrovascular tumor thrombosis (MVTT) is common among patients with advanced hepatocellular carcinoma (HCC), and it contains two main types, portal vein tumor thrombus (PVTT) and hepatic vein tumor thrombus (HVTT). MVTT is a significant prognostic factor, and the prognosis of HCC with MVTT remains unsatisfactory. The classification of MVTT varies in different studies, and the management of HCC and MVTT differs among Eastern and Western countries. Over the past years, a multidisciplinary approach, including surgical resection, radiotherapy, and transcatheter arterial chemoembolization, especially the advent of new targeted drugs and immune checkpoint inhibitors, has brought considerable survival benefits for HCC patients with MVTT. Recently, multiple novel treatment strategies, such as neoadjuvant therapy or tumor downstaging based on radiotherapy, immunotherapy, and molecular-targeted therapy, have broadened the treatment landscape of MVTT. In this review, we conclude the consensus and progress regarding diagnosis and treatment for patients with HCC and MVTT.