| Background and Aims Primary liver cancer(PLC)is a common malignant tumor.Every year the number of new patients and the high death are increasing.Liver cancer cells have characteristics of high degree of malignancy,rapid progress,strong invasion,and found later.Most of the patients have been found at advanced stage.One of the most important characteristics of the development of primary liver cancer is the invasion of cancer cells into portal vein.Once the portal vein tumor thrombus is formed,the prognosis is poor.without treatment,the survival period is generally 2-7 months.Portal vein tumor thrombus is usually invaded from portal vein branches.It is easy to cause liver function damage,intractable ascites,esophageal varices bleeding and so on.There is no effective method for the treatment of portal vein tumor thrombus.EASL guidelines suggest that sorafenib treatment is the only means.The aim of this study was to investigate the patients with primary hepatic carcinoma invading the branch portal vein but not invading the main portal vein.We research method for treating primary liver cancer with portal vein tumor thrombus by two methods: Treatment with TACE alone and TACE combined with microwave ablation.We Expect to improve the prognosis of these patients,providing some new ideas for the treatment of primary hepatic carcinoma invading branch portal vein.Methods This study retrospectively analyzed the clinical data of 145 cases of primary liver cancer with portal vein tumor thrombus.The data were divided into two groups: One group(71 patients)received TACE+ branch tumor thrombus ablation therapy;The other group(74 patients)were treated with TACE alone.Through the comparative analysis of two groups of patients survival time and complications,we study on the therapeutic effect of the two groups whether there are differences in.Further analysis of the related factors(Kaplan-Meier)was used to analyze the survival rate and the COX risk ratio model for multivariate analysis.Results 1.The near future curative effect comparison in two groups of patients with cancer embolus volume change of cancer embolus For all patients with post operation after 1 month,the effect of the treatment group controlling cancer embolus in the branch of portal vein is obvious.Among these,The tumor emboli volume changes in treatment group after 1 month are as follow: DCR is 94.4%;While in the control group,DCRis 91.8%,,P>0.05.3 month are as follow: DCR is 86.1%;While in the control group,DCRis 68.5%,,P<0.05.6 month are as follow: DCR is 68.1%;While in the control group,DCRis 38.4%,In comparison,the difference between two groups of patients is statistically significant(P < 0.05).2.To compare OS with the two groups of patients,the treatment group and control group in OS is respectively 16.4 months and 11.3 months,the differences between the two groups was statistically significant(P < 0.05)According to the different types of tumor thrombi stratified,58 cases of I type of cancer embolus,the median survival time was 16.6 months.The patients with type II tumor thrombus in a total of 87 cases,the median survival time was 14.3 months.There was a significant difference in survival time between the different types of cancer embolus(P=0.019).In the treatment group,28 cases of I type of cancer embolus,the median survival time was 19.4 months,II type of cancer embolus in 44 cases,the median survival time was 16.4 months.The overall survival of the two groups was P=0.417.145 cases were included in patients with newly diagnosed type I found cancer embolus in 58 cases,28 cases in the treatment group,the median survival time was 19.4 months;30 cases in the control group,the median survival time was 16.6 months,no significant differences between the two groups(P=0.291).A total of 87 cases of II type of cancer embolus were found in the first visit,and the treatment group(n = 44)had a median survival time of 16.4 months.The median survival time of the control group was 9.7 months,and the survival time of the two groups was statistically significant(P=0.000).3.The analysis in influence of the OS single factor and multiple factors Through the analysis,we found that the main factors affecting the survival time of the patients in the two groups were PMWA treatment,AFP level,the type of cancer embolus,the maximum diameter of the primary tumor and the number of tumor.Then all single factors were included in the multivariate COX analysis model,and the results showed that whether PMWA treatment,the type of cancer embolus,the number of tumors and the maximum diameter of the primary tumor were the independent factors affecting the survival time of patients.Among them,PMWA treatment was the protective factor,II type of tumor thrombus,tumor number >3 and tumor maximum diameter >5cm were risk factors.These results suggest that PMWA can reduce the risk of death in patients with portal vein tumor thrombus,and the risk of death in patients with type II portal vein tumor thrombus,tumor number >3 and maximum tumor diameter of >5cm can be increased.4.Comparison of two groups of patients with adverse reactions Both of these two groups of patients with adverse reactions are local liver area pain,fever,nausea and vomiting,elevated aminotransferase,rise of total bilirubin.The treatment group postoperative complications occurred in 1 cases of biliary thermal injury,1 cases of gastrointestinal bleeding,arteriovenous fistula in 2 cases;tumor rupture and bleeding complications occurred in 1 cases after surgery in the control group,1 cases of gastrointestinal bleeding,1 cases of cholecystitis,1 cases of hematoma puncture points.It may be suggested that the treatment of portal vein tumor thrombus by PMWA is a safe treatment.Conclusion For patients with primary hepatic carcinoma with portal vein branch tumor emboli,the treatment group combining with TACE and microwave ablation PMWA can delaying tumor thrombus by portal vein branch to the main development process and prolong the survival time of patients with PVTT.Microwave ablation PMWA combined with arterial chemoembolization TACE treatment compared with TACE alone,did not produce more adverse reactions and complications,considered as a relatively safe treatment. |
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