Journal: Zhonghua yi xue za zhi
This publication presents the 2026 updated Chinese guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), a condition characterized by high incidence and extremely poor prognosis.
Key points:
- Rationale for update: Reflects new evidence accumulated since the 2021 edition, with a focus on Chinese patients, whose etiologies and tumor biology may differ from Western populations.
- Methodology:
- Systematic literature review up to October 2025.
- Evidence graded using the GRADE system.
- Recommendations formed through multidisciplinary expert consensus.
- PVTT classification: Recommends Cheng’s classification as the national standard for PVTT typing in China.
- Treatment principles:
- Strong emphasis on multidisciplinary team (MDT) decision-making.
- Advocates individualized, comprehensive treatment based on liver function, tumor resectability, and PVTT type.
- Resectable disease (type I/II PVTT): Surgical resection is recommended as the preferred treatment for suitable candidates.
- Unresectable disease: Recommends combined local and systemic therapy, including:
- Local: hepatic arterial infusion chemotherapy (HAIC), transarterial chemoembolization (TACE), and radiotherapy.
- Systemic: targeted therapy and immunotherapy.
- Additional considerations:
- Highlights the role of conversion therapy (aiming to render initially unresectable disease resectable).
- Stresses the importance of supportive care alongside antitumor treatment.
- Future directions:
- Calls for refinement of staging systems specific to HCC with PVTT.
- Encourages further mechanistic research to better understand disease biology and guide therapy.
Overall, the guideline provides an updated, evidence-based framework aimed at standardizing and optimizing care for HCC with PVTT in China, with the goal of improving survival and quality of life.