Targeted therapy pathways in the liver, guiding surgeon's hand.

Surgical Success: How to Identify the Right Liver Cancer Patients

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"A novel approach using localized therapy could revolutionize liver cancer treatment by carefully selecting patients who will benefit most from surgery."

Hepatocellular carcinoma (HCC), a type of liver cancer, often presents with a serious complication: portal vein tumor thrombosis (PVTT). This means the cancer has invaded the main vein that carries blood to the liver, making treatment challenging. Historically, HCC with PVTT has a poor prognosis, with patients surviving less than a year.

While surgery offers the best chance for long-term survival, it's not suitable for everyone. Identifying which patients will truly benefit from surgery is crucial. Researchers have been exploring ways to improve patient selection and outcomes, leading to innovative treatment strategies.

One such strategy involves using localized concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC). This approach aims to shrink the tumor and control its spread before considering surgery. A recent study investigated whether this combination can help identify optimal surgical candidates among HCC patients with PVTT.

Localized Therapy: A Game-Changer for Surgical Selection?

Targeted therapy pathways in the liver, guiding surgeon's hand.

The study evaluated the impact of localized CCRT and HAIC on subsequent surgical resection. The goal was to determine if this combined treatment could effectively select patients who would benefit most from surgery. The researchers compared outcomes of patients who underwent immediate resection versus those who received CCRT/HAIC followed by resection if their tumors responded.

Interestingly, there wasn't a significant difference in disease-specific survival between the 'localized CCRT' and 'resection' groups. However, when comparing 'resection after CCRT' to 'resection' alone, the 'resection after CCRT' group showed a significantly longer disease-specific survival. This suggests that CCRT acts as a filter, allowing surgery to be performed on patients who have already demonstrated a positive response to treatment.

Improved Resection Rates: Downstaging with CCRT led to a 26.5% resection rate.
Second-Order PVTT Advantage: Patients with second-order PVTT (tumor thrombus further away from the main portal vein) had a higher resection rate (50%) compared to first-order PVTT (21%).
Favorable Tumor Biology: Patients with second-order PVTT demonstrated better responses to treatment, suggesting a less aggressive tumor type.

The location of PVTT proved to be a critical factor influencing outcomes after resection. The study found that patients downstaged from first-order to second-order PVTT, or those without any portal vein invasion after CCRT, experienced better results. This indicates that localized CCRT may help select patients with more favorable tumor biology, even those initially presenting with aggressive first-order PVTT.

The Future of Liver Cancer Treatment: Personalized Approaches

The study highlights the importance of personalized treatment strategies in liver cancer. As Blake Cady wisely stated, "biology is king, selection is queen." The presence of PVTT indicates aggressive tumor behavior, making careful patient selection crucial for successful surgical outcomes.

While surgical resection remains the primary hope for a cure, reliable patient selection criteria have been lacking. This research demonstrates that downstaging achieved with localized CCRT can serve as an effective tool for identifying optimal surgical candidates with favorable tumor biology.

However, the retrospective nature and limited sample size of the study call for further prospective research. Future investigations should focus on identifying factors associated with radiologic response after CCRT to refine the downstaging strategy and maximize patient benefits. Additionally, exploring factors that promote liver regeneration after localized CCRT is essential to increase resectability and improve outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1245/s10434-018-7018-0, Alternate LINK

Title: Aso Author Reflections: Identifying Optimal Surgical Candidates In Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

Subject: Oncology

Journal: Annals of Surgical Oncology

Publisher: Springer Science and Business Media LLC

Authors: Jae Uk Chong, Jin Sub Choi

Published: 2018-12-18

Everything You Need To Know

What is portal vein tumor thrombosis (PVTT) and why is it significant in liver cancer?

Portal vein tumor thrombosis (PVTT) is a serious complication in hepatocellular carcinoma (HCC) where the cancer invades the portal vein, which carries blood to the liver. Historically, HCC with PVTT has a poor prognosis. The presence of PVTT signifies aggressive tumor behavior, complicating treatment and impacting survival rates. The location of the portal vein tumor thrombus also influences outcomes. For example, those with second-order PVTT have a higher resection rate, indicating less aggressive tumor biology.

What is localized concurrent chemoradiotherapy (CCRT) and how does it help in treating liver cancer?

Localized concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) is used to shrink the tumor and control its spread before considering surgery. The goal of CCRT/HAIC is to act as a filter, allowing surgery to be performed on patients who have already demonstrated a positive response to treatment. This approach is particularly relevant for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT).

How does the location of portal vein tumor thrombosis (PVTT) influence the outcome of liver cancer treatment?

The location of portal vein tumor thrombosis (PVTT) significantly affects the outcomes of liver cancer treatment. Patients with second-order PVTT (tumor thrombus further away from the main portal vein) tend to have better responses and higher resection rates compared to those with first-order PVTT (tumor thrombus closer to the main portal vein). Downstaging from first-order to second-order PVTT or complete elimination of portal vein invasion after localized concurrent chemoradiotherapy (CCRT) is associated with improved results.

What resection rates can be achieved by downstaging hepatocellular carcinoma (HCC) using localized concurrent chemoradiotherapy (CCRT)?

Downstaging hepatocellular carcinoma (HCC) using localized concurrent chemoradiotherapy (CCRT) led to a 26.5% resection rate in the study. Patients who initially presented with first-order portal vein tumor thrombosis (PVTT) and were downstaged to second-order PVTT, or had no PVTT after CCRT, experienced improved outcomes. Second-order PVTT had a 50% resection rate compared to 21% in first-order PVTT. This implies that localized CCRT might select those with more favorable tumor biology.

Why is careful selection of liver cancer patients so important when using localized therapy, and what approach is used to make these decisions?

The selection of liver cancer patients using localized therapy is pivotal due to the aggressive nature of hepatocellular carcinoma (HCC), especially when complicated by portal vein tumor thrombosis (PVTT). By using a combination of localized concurrent chemoradiotherapy (CCRT) and hepatic arterial infusion chemotherapy (HAIC), clinicians can identify patients who are more likely to benefit from subsequent surgical resection. This personalized approach, guided by the principle that 'biology is king, selection is queen,' allows for better outcomes and improved survival rates by ensuring surgery is performed on patients who have demonstrated a positive response to the initial treatment.