[Guidelines for diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus in China(2026 edition)].

Résumé

Hepatocellular carcinoma with portal vein tumor thrombus (PVTT) has a high incidence and an extremely poor prognosis. Current international guidelines still exhibit discrepancies in the diagnosis and management of PVTT, while Chinese patients require individualized strategies due to differences in etiology and biological behavior. To adapt to the developments and changes in the clinical diagnosis and treatment of hepatocellular carcinoma with PVTT, and to standardize related clinical procedures, the Chinese Association of Liver Cancer and Chinese Medical Doctor Association initiated the revision of the"Chinese Guidelines for Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus (2026 Edition)"in 2025, which was the new evidence since the publication of the 2021 edition. This guideline was developed through a systematic literature search up to October 2025, evaluated the evidence using the GRADE system, and formulated recommendations via multidisciplinary expert consensus. The guideline recommends Cheng's classification as the Chinese standard for PVTT typing, emphasizes a multidisciplinary team (MDT)-based approach, and advocates for individualized comprehensive treatment strategies based on liver function, tumor resectability, and PVTT type. For patients with resectable type Ⅰ/Ⅱ PVTT, surgical resection is the preferred option; for unresectable cases, a combination of local therapies such as hepatic arterial infusion chemotherapy (HAIC), transarterial chemoembolization (TACE), and radiotherapy with systemic therapies including targeted and immunotherapy is recommended. Furthermore, the guideline clarifies the importance of conversion therapy and supportive care, and outlines future research directions, including optimizing staging systems and deepening mechanistic studies. This guideline aims to provide the latest evidence-based basis for the standardized diagnosis and treatment of hepatocellular carcinoma with PVTT, with the goal of improving patient survival and quality of life.