Comparative Analysis Of The Efficacy Of TACE Combined With Apatinib Or ¹²⁵I Seed Implantation In The Treatment Of Portal Vein Tumor Thrombus In Hepatocellular Carcinoma

Background and Objective:Primary liver cancer is a common clinical tumor and has become the fourth most common cause of death worldwide,of which about 90%are diagnosed as hepatocellular carcinoma（HCC）.Due to the extremely long incubation period,more than 40%of HCC patients were diagnosed with advanced HCC at the time of diagnosis,of which 62.2%-90.0%were associated with Portal vein tumor thrombus（PVTT）.The results indicated that arterial ¹²⁵I implantation combined with TACE could effectively prolong the survival of HCC with PVTT.In addition,TACE combined with apatinib has been shown to prolong survival in patients with PVTT HCC.There are few reports on TACE combined with apatinib in the treatment of PVTT.However,for patients withⅡtype PVTT,CT-guided seeds implantation is recommended.Therefore,patients with HCC withⅡtype PVTT were included in this study to retrospectively compare the efficacy and safety of TACE combined with apatinib or¹²⁵I seed implantation in the treatment of HCC with PVTT,and to study the factors affecting prognosis.Material and Methods:In this study,we collected 66 patients with HCC with PVTT in the Affiliated Cancer Hospital of Zhengzhou University from January 2018 to December 2019Among them,32 patients received TACE+apatinib treatment and 34 patients received TACE+¹²⁵I seed implantation treatment.The relevant clinical data were analyzed retrospectively,and the efficacy was evaluated.The time of disease progression and survival of patients were counted,the median progression-free survival and median survival of patients were calculated,the survival curve was plotted by Kaplan-Meier method,and the prognostic factors affecting the survival of patients were analyzed.The relevant complications after treatment were counted and their corresponding grades were evaluated.Result:For portal emboli,the disease control rate of TACE+Apatinib group was 21.88%,which was lower than that of TACE+¹²⁵I seed group（79.41%,P<0.05）,and the difference was statistically significant.The objective response rate was 0 in the TACE plus apatinib group and 38.24%in the TACE plus ¹²⁵I seed group（P<0.001）.In terms of primary liver lesions,the disease control rate of the TACE+Apatinib group was90.63%,and that of the TACE+¹²⁵I seed group was 85.29%（P>0.05）,the difference was not statistically significant.The objective response rate of TACE combined with apatinib group was 75.00%,which was higher than that of TACE combined with¹²⁵I seed group（61.76%,P=0.249）.The median progression-free survival（PFS）in the TACE+Apatinib group was 6.7 months.TACE+¹²⁵I seed group was 10.5 months（P<0.001）.The median survival time was 10.0 months in the TACE+Apatinib group and12.2 months in the TACE+¹²⁵I seed group（P=0.007）.The median OS ofⅡa type was 11.1 months and TACE+¹²⁵I seed group was 13.1 months（P=0.047）.The median OS ofⅡb in the TACE+apatinib group was 8.6 months,TACE+¹²⁵I seed group is11.4 months（P=0.140）.Univariate analysis showed that the treatment mode,Alpha fetoprotein level and PVTT classification were related factors affecting OS in patients with HCC.Multivariate analysis showed that the type and treatment of PVTT were independent factors affecting the overall survival time of HCC patients.Conclusion:TACE+¹²⁵I seed implantation in the treatment of HCC complicated with PVTT can effectively control the progression of PVTT,prolong the survival and progression-free survival of patients,and can be repeated treatment without serious complications.Multivariate analysis showed that the type and treatment of PVTT were independent factors of overall survival in HCC patients.