Comparison Of Clinical Efficacy Of TACE And Surgical Resection In HCC Patients With Type Ⅰ/Ⅱ PVTT

Background:Primary liver cancer is a common malignant tumor in China.Hepatocellular carcinoma(HCC)is the main pathological type.HCC is easy to invade the portal vein and form portal vein tumor thrombus(PVTT),which leads to intrahepatic dissemination and portal hypertension.It seriously affects the survival and prognosis of the patients and has become the clinical difficulty and hot issue.In recent years,with the deepening understanding of the formation mechanism of PVTT and the continuous improvement of treatment methods,the prognosis of the patients has also improved.At present,transcatheter arterial chemoembolization(TACE),surgical resection and multidisciplinary treatment have become the main treatment of HCC with PVTT.Different views still exist on how to choose appropriate treatment to maximize the benefits of the patients.Therefore,it is necessary to summarize the therapeutic effects of different methods on HCC with PVTT,so as to select a better method.Objective:To summarize the therapeutic effect of TACE and surgical resection in HCC patients with type I/II PVTT.Methods:A total of 80 HCC patients with type I/II PVTT from June 2015 to November 2018 were collected,which divided into operation group(40 cases)and TACE group(40 cases)according to the different treatments.The clinical data of the two groups were analyzed,including age,gender,PVTT type,TBil,ALB,AST,PT,AFP,platelet count,HBs Ag,number of tumors,maximum diameter of tumor,total diameter of tumors.Meanwhile,the serum TBIL,ALB and PT were compared before and after treatment on 1st,3rd and 5th days.Imaging examination was performed one month after treatment.According to the modified response evaluation criteria in solid tumors(m RECIST),the therapeutic effects of intrahepatic lesions and tumor thrombi were evaluated.All patients were followed up by outpatient,inpatient and telephone contact.The survival time and 0.5,1,2 and 3-year survival rates were recorded.The survival time of the two groups was compared.Results:There was no significant differences in baseline characteristics between the two groups.There was no significant differences in serum TBIL,ALB and PT between the two groups on the 1st,3rd and 5th day after treatments(P>0.05).No serious complications such as massive hemorrhage,septic shock,death and so on occured in both groups.The median survival time of operation group(17.1 months)was longer than that of TACE group(8.5 months),and the difference was statistically significant(x~2=8.165,P=0.009).The 0.5-year,1-year,2-year and 3-year survival rates of operation group(77.5%,55.0%,32.5%and 15.0%)were higher than those of TACE group(60.0%,27.5%,15.0%and 10.0%),and the difference was statistically significant(x~2=5.031,P=0.024).The survival curve of operation group was better than that of TACE group(x~2=4.117,P=0.041).The total tumor control rate of the surgery group(82.5%)was higher than that of the TACE group(65.00%)(x~2=4.765,P=0.035).Univariate analysis showed that PVTT type(type I/II),Child-Pugh classification(A/B),number of tumors(single/multiple),maximum diameter of tumor(≤7/>7cm)and AST(≤34/>34U/L)had an impact on the survival time of patients(P<0.05),while gender(male/female),age(≤50 years/>50 years),HBs Ag(negative/positive),total diameter of tumors(≤9/>9cm),AFP value(≤400/>400ng/m L),platelets(≤100/>100×10~9/L)had no statistical significance on the prognosis of patients(P>0.05).Through multivariate Cox proportional hazard regression model analysis,PVTT type(type I/type II),tumor number(single/multiple)and maximum diameter of tumor(≤7/>7cm)were independent prognostic factors that affected the survival time of patients with HCC combined with typeⅠ/ⅡPVTT.Conclusion:For HCC patients with type I/II PVTT,the curative effect of surgical resection is better than that of TACE.The PVTT type,the number of tumors and the maximum diameter of tumor were the independent prognostic factors for overall survival.