Theeffectofportalveintumorthrombus(PVTT)ontheprognosisofpatientswithhepatocellularcarcinomahasbecomeclearoverthepastseveraldecades.However,identifyingthemechanismsandperformingthediagnosisandtreatmentofPVTTremainchallenging.Therefore,thisstudyaimedtosummarizetheprogressintheseareas.AcomputerizedliteraturesearchinMedlineandEMBASEwasperformedwiththefollowingcombinationsofsearchterms:'hepatocellularcarcinoma'AND'portalveintumorthrombus.'AlthoughseveralsignaltransductionormolecularpathwaysrelatedtoPVTThavebeenidentified,theexactmechanismsofPVTTarestilllargelyunknown.Manybiomarkershavebeenreportedtodetectmicrovascularinvasion,butnonehaveprovedtobeclinicallyusefulbecauseoftheirlowaccuracyrates.SorafenibistheonlyrecommendedtherapeuticstrategyinWesterncountries.However,moretreatmentoptionsarerecommendedinEasterncountries,includingsurgery,radiotherapy(RT),transhepaticarterialchemoembolization(TACE),transarterialradioembolization(TARE),andsorafenib.Therefore,weestablishedastagingsystembasedontheextentofportalveininvasion.Ourstagingsystemeffectivelypredictsthelong-termsurvivalofPVTTpatients.Currently,severalclinicaltrialshadshownthatsurgeryiseffectiveandsafeinsomePVTTpatients.RT,TARE,andTACEcanalsobeperformedsafelyinpatientswithgoodliverfunction.However,onlyafewcomparativeclinicaltrialshadcomparedtheeffectivenessofthesetreatments.Therefore,morerandomizedcontrolledtrialsexaminingtheextentofPVTTshouldbeconductedinthefuture.
