The Survival Analysis Of Transarterial Chemoembolization Plus Three Dimensional Radiotherapy For Hepatocellular Carcinoma Combined With Portal Vein Tumor Thrombosis

ObjectivesHepatocellular carcinoma (HCC) is the fifth caner disease in the world. It has beenreported50to100million new patients every year and30%patients are combined withportal vein tumor thrombosis (PVTT) when diagnosed. PVTT often causes extensiveintrahepatic dissemination of the tumor through the portal tract, can decrease blood supplyto the normal liver, and finally cause portal hypertension resulting in the rupture ofcollateral vessels and deteriorating liver function. If left untreated, the median survivaltime is only2.7months. Transarterial chemoembolization is the first line of treatment ininoperable hepatocellular carcinoma, radiotherapy has been considered as an alternativetreatment modality along with the radiation technology. This study aims to assess thesurvival analysis of TACE plus three dimensional conformal radiotherapy (3DCRT) forHCC with PVTT and discuss the Prognostic factors.MethodsThis study respectively assessed128patients (TACE group:61patients;TACE+3DCRT group B:67patients) clinical data and follow-up. Survival rate wascalculated by the Kaplan-Meier method and compared statistically using the Log rank test.In order to identify the independent factors for survival, variables that associated withsurvival in univariate analysis were subsequently included in the multivariate analysisusing Cox proportional hazard model, meanwhile, stratified the portal vein tumorthrombosis into two types: type Ⅰ: portal vein tumor thrombosis was located in the firstbranch or above. Ⅱ. portal vein tumor thrombosis was located in the main branch.Results1.The overall median survival was6.6months in all patients. The survival wassignificantly better in TACE+3DCRT group than in the TACE group (median survival 10.5months vs.4.2months, P=0.000). The1-,2-, and3-year survival rates were18.0%,9.8%, and0%in group TACE; in group TACE+3DCRT were40.3%,27.6%, and8.5%.The median survival in TACE+3DCRT group compare with TACE group was10.5and6.1months for the type Ⅰ PVTT（P=0.040）. For type Ⅱ, the median survivals were8.5and3.4months（P=0.000）.2. In univariate analysis, the following4of14potential variables significantlyaffected survival time: ECOG performance status, Tumor size, TACE (times), Treatmentmodel;3. In multivariate analysis, only Tumor size (RR,2.977;95%CI,1.969~4.998;P=0.000), TACE (times)(RR,2.197;95%CI,1.453~3.322; P=0.000) and Treatment model(RR,1.827;95%CI,1.247~2.676; P=0.002) were confirmed as independent prognosticfactors.ConclusionsTACE combined3DCRT had significantly better survival for HCC with differentextent PVTT, especially PVTT in the main branch. Tumor size diameter less than100mm,TACE time more than three times and radiotherapy are the good independent prognosisfactors for patients.