Efficacy And Safety Of Image-guided¹²⁵I Seed Implantation Combined With TACE In The Treatment Of Primary Hepatocellular Carcinoma Complicated With Portal Vein Tumor Thrombus:A Meta-analysis

Objective:To compare the efficacy and safety of"image-guided¹²⁵I seed implantation combined with TACE therapy"and"TACE therapy"in primary liver cancer complicated with portal vein tumor thrombus,and to provide guidance and suggestions for patients who refuse operation and can not tolerate operation to choose a more reasonable and effective treatment.Methods:The five authoritative databases of CNKI,Pubmed,Wanfang,Embase and Cochrane Library were selected to search the Chinese and English literatures about"image-guided¹²⁵I seed implantation combined with TACE therapy"for primary liver cancer complicated with portal vein tumor thrombus.The date is set from the establishment of the database to December 2021.The Chinese key words are primary liver cancer,liver cancer,portal vein tumor thrombus,¹²⁵I seed,etc.,while the English key words are Primaryhepatocellularcarcinoma,PVTT,¹²⁵I Seed,TACE and so on.The two researchers screened the literature independently of each other,and the screening criteria were the inclusion and exclusion criteria established in advance,and then the two researchers cross-examined the screened literature.once there were differences,they gave it to the third author to make a choice.Then select the applicable quality evaluation method to evaluate the final included literature.After evaluation,the data that need to be analyzed are extracted.Then,using Rev Man5.4 software to do statistical analysis,from the aspects of tumor control rate,remission rate,control rate,remission rate,survival rate and adverse reactions of patients with portal vein tumor thrombus,we analyzed and compared the efficacy and safety of"image-guided¹²⁵I seed implantation combined with TACE group"and"TACE group"in the treatment of primary liver cancer complicated with portal vein tumor thrombus.We used Stata16 software to make a funnel chart of the extracted data.And combined with Egger to test whether there is publication bias in the data.Result:Finally,4 randomized controlled trials and 10 retrospective studies were included in this study.A total of 1441 patients with primary liver cancer complicated with portal vein tumor thrombus were included in this study,of which 679 cases in the experimental group were treated with image-guided125i seed implantation combined with TACE,and 762 cases in the control group were treated with"single TACE".Meta-analysis showed that:1.The tumor control rate（OR=1.86,95%CI:1.20～2.88,P=0.006）and objective remission rate（OR=1.70,95%CI:1.15～2.51,P=0.007）in the experimental group were better than those in the control group.2.The PVTT control rate（OR=5.72,95%CI,2.71～12.05,P<0.00001）and objective remission rate（OR=5.00,95%CI:3.57～7.00,P<0.00001）in the experimental group were better than those in the control group.3.Compared with the control group,the experimental group could significantly improve the 3-month survival rate（OR=5.66,95%CI:3.25～9.87,P<0.00001）,6-month survival rate（OR=4.36,95%CI:3.27～5.81,P<0.00001）,12-month survival rate（OR=4.15,95%CI:3.03～5.68,P<0.00001）,24-month survival rate（OR=2.45,95%CI:1.37～4.38,P=0.003）and 36-month survival rate（OR=2.21,95%CI:1.51～3.22,P<0.0001）.4.There was no significant difference in the incidence of adverse reactions between the experimental group and the control group.Conclusion:"Image-guided radioactive¹²⁵I seeds combined with TACE in the treatment of primary liver cancer with portal vein tumor thrombus"and"TACE in the treatment of primary liver cancer with portal vein tumor thrombus":（1）the former can significantly improve the tumor control rate,portal vein tumor thrombus control rate,tumor objective remission rate and portal vein tumor thrombus objective remission rate;（2）the former can significantly improve the survival rate of patients;（3）the former does not increase adverse reactions and postoperative complications are improved by symptomatic treatment.Image-guided¹²⁵I seed implantation combined with TACE in the treatment of primary liver cancer with portal vein tumor thrombus is safe and feasible,and the therapeutic effect is better.