Surgical Resection Plus Transcatheter Arterial Chemoembolization For Patients With Hepatocellular Carcinoma (HCC) And Concomitant Portal Vein Tumor Thrombus(PVTT):an Analysis Of Therapeutic Efficacy

Objective To investigate the surgical treatment and the efficacy for patients with hepatocellular carcinoma(HCC)and concomitant portal vein tumor thrombus(PVTT),and the prognostic factors affecting survival after therapy in a case-controlled studey.Methods A retrospective study was carried out on 217 patients who underwent different treatments for HCC with PVTT at the Hospital from January 2009 to June2012.The patients were divided into three groups according different treatment:(1)the conservative treatment group(group A,n=34);(2)the sorafenib treatment group(group B,n=55);(3)the surgical resection combined with transcatheter arterial chemoembolization(TACE)group(group C,n=128).In detail,the patients of A group were treated with drugs to protect the liver function,enhance immunity and resist tumor;the patients of B group were received treatment of oral sorafenib at a dose of 400 mg/times and 2 times/day,which was adjusted the dose depending on adverse reactions during treatment;the patients of C group were underwent surgical treatment(71 patients with hepatocellular carcinoma,portal vein tumor thrombus and the involved portal vein resection,57 patients with resection of hepatocellular carcinoma combined with portal vein incision or liver section to remove the tumor thrombus)followed by TACE at one month after the operation.The 0.5-,1-,2-,and 3-year survival rate,overall survival(OS)and time to tumor progression(TTP)and the prognostic factors affecting survival after therapy of the patients were analyzed.Results In conservative treatment group,the 0.5-,1-,2-,and 3-year survival rate for patients was 11.8%,0%,0% and 0%;in sorafenib treatment group,the 0.5-,1-,2-,and 3-year survival rate for patients was 83.6%,34.5%,3.64% and 0%;In combination treatment group,the 0.5-,1-,2-,and 3-year survival rate for patients was 84.4%,55.5%,14.8% and 5.47%.The median OS and TTP for patients in conservative treatment group was 3 and 1 months,for which patients in sorafenib treatment group was 9 and 4 months and in combination treatment group was 12.5and 5 months.Statistical analysis showed that both median OS and TTP for patients either the sorafenib treatment group or the combination treatment group were significantly longer than those for patients in conservative treatment group(all P<0.05),and the combination treatment was more advantageous.Analysis showed there were no significant differences among the three groups in the base-line clinical data which included the ECOG score,the type of PVTT,the Child-Pugh score,the a-fetoprotein(AFP)level,and the size of tumor(all P>0.05).Univariate analysis and multivariate analysis revealed that the type of PVTT,the retention rate of ICG in 15 minutes(ICG R15%),the number of TACE affected the prognosis.Conclusion(1)Surgical resection followed by TACE treatment can be performed for HCC patients with PVTT,which may offer better efficacy than lone sorafenib or conservative treatment.(2)We should pay great attention to these factors affecting the prognosis that include the type of PVTT,the retention rate of ICG in15 minutes(ICG R15%)and the number of TACE.