{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:54:45Z","timestamp":1781585685684,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vascular invasion by hepatocellular carcinoma (HCC), particularly involving the main portal vein or inferior vena cava (IVC), is associated with poor prognosis. However, contemporary real\u2010world outcomes and the clinical benefit of liver\u2010directed therapies (LDT) in this setting are poorly defined. We evaluated outcomes of patients with vascular invasion managed in a multidisciplinary liver cancer clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed outcomes for patients with HCC who presented to the Johns Hopkins Liver Multidisciplinary Clinic between 2020 and 2024, with radiographic evidence of the tumor thrombus in the main portal vein and\/or IVC. Overall (OS) and progression\u2010free survival and gastrointestinal variceal bleeding incidence were evaluated. Associations between clinical variables and outcomes were analyzed using the Cox proportional hazards regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010four patients met our study criteria. Forty\u2010eight patients (89%) had portal vein main trunk invasion, and 13 (24%) had IVC tumor thrombus. Treatment included systemic therapy alone in 30 patients (56%), systemic therapy and LDT in 15 patients (28%), best supportive care in six patients (11%), and LDT alone in three patients (6%). Median OS was 5.7\u2009months (95% CI: 2.6\u201312\u2009months). Median survival was shorter among patients with IVC involvement (4.1\u2009months, 95% CI: 0.82\u20135.7\u2009months) than those without (7.6\u2009months, 95% CI: 2.3\u201317\u2009months), which was independently associated with worse prognosis in multivariable analysis (HR: 4.0, 95% CI: 1.5\u201311,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0051). Other significant findings of multivariable analysis include performance status (HR: 7.2, 95% CI: 2.7\u201319,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and viral hepatitis (HR: 0.46, 95% CI: 0.23\u20130.79,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027). Four patients (7%) experienced bleeding esophageal varices requiring intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HCC with tumor thrombus involving the main portal vein and\/or IVC is associated with poor survival in real\u2010world clinical practice. Prospective studies are needed to define the optimal management of this high\u2010risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71984","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T03:43:56Z","timestamp":1779507836000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of Hepatocellular Carcinoma involving the Portal Vein Main Trunk and\/or the Inferior Vena Cava: Experience From a Multidisciplinary Liver Cancer Clinic"],"prefix":"10.1002","volume":"15","author":[{"given":"I\u2010Chia","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology &amp; Molecular Radiation Sciences The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atif","family":"Zaheer","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Sciences The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Hu","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Bioinformatics Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Shubert","sequence":"additional","affiliation":[{"name":"Department of Surgery The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Lafaro","sequence":"additional","affiliation":[{"name":"Department of Surgery The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Surgery The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Burkhart","sequence":"additional","affiliation":[{"name":"Department of Surgery The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"He","sequence":"additional","affiliation":[{"name":"Department of Surgery The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Philosophe","sequence":"additional","affiliation":[{"name":"Department of Surgery The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Zorzi","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Comprehensive Cancer Center The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige","family":"Griffith","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Comprehensive Cancer Center The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra T.","family":"Strauss","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy K.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Liddell","sequence":"additional","affiliation":[{"name":"Division of Vascular and Interventional Radiology Department of Radiology and Radiological Sciences The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Vascular and Interventional Radiology Department of Radiology and Radiological Sciences The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Georgiades","sequence":"additional","affiliation":[{"name":"Division of Vascular and Interventional Radiology Department of Radiology and Radiological Sciences The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Anders","sequence":"additional","affiliation":[{"name":"Department of Pathology The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoko","family":"Oshima","sequence":"additional","affiliation":[{"name":"Department of Pathology The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa","family":"Hallab","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Comprehensive Cancer Center The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amol","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology &amp; Molecular Radiation Sciences The Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2644-5086","authenticated-orcid":false,"given":"Won Jin","family":"Ho","sequence":"additional","affiliation":[{"name":"Sidney Kimmel 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