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HCC Portal Vein Invasion — SCE Medical Oncology MCQ

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ModerateGI CancersHCC Portal Vein InvasionSCE Medical Oncology

A 72-year-old man with advanced HCC and portal vein thrombosis (tumour thrombus in main portal vein — Vp4) is being assessed for treatment. How does main portal vein invasion affect prognosis and treatment selection?

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Correct answer: C — Main portal vein tumour thrombosis (Vp4) represents BCLC-C disease with poor prognosis; systemic therapy (atezolizumab + bevacizumab or durvalumab + tremelimumab) is indicated, but TACE is contraindicated due to risk of hepatic ischaemia/failure

Main portal vein tumour thrombosis (Vp4) is one of the most adverse prognostic features in HCC. TACE is generally contraindicated because occluding the hepatic artery in the presence of portal vein occlusion risks hepatic ischaemia. Systemic therapy is the standard treatment. Radioembolisation (Y-90 SIRT) may be used in selected cases of segmental/lobar PVT but not main PVT. Sorafenib was the historical standard; ICI-based regimens are now first-line for Child-Pugh A.

Reference: ESMO 2024 HCC; NICE TA816; BCLC Staging; AASLD Guidelines