Evaluation Of The Efficacy And Safety Portal Vein Stent Combined With Iodine-125 Seed Implantationa Or Radiofrequency Ablation In The Treatment Of Hepatocellular Carcinoma With Portal Vein Thrombosis

Background: HCC?Hepatocellular carcinoma,primary liver cancer?patients are often associated with the formation of portal vein tumor thrombus?PVTT?.The incidence of PVTT in the course of HCC is reported to be 44% to 62.2%,which is an independent risk factor that affects the prognosis of HCC patients.If no effective treatment measures are taken,the median survival time is only 2.7-4.0 months.For patients with PVTT,currently the main treatment methods include transcatheter arterial chemoembolization?TACE?,surgery,radiotherapy,and targeted therapy,but the efficacy is not satisfactory.Recent studies have reported that PVS?Portal vein stent?combined with¹²⁵ I particle chain implantation or portal vein RF catheter ablation has achieved good results in the treatment of PVTT.But so far,There is no report comparing PVS combined with¹²⁵ I particle chain or radiofrequency ablation catheter ablation;and there are no reports on specific recommended treatment methods for different types of portal vein tumor thrombi.Objective: To compare the two treatments by assessing PVTT imaging,adverse reactions,clinical symptoms,AFP,liver function-related indicators,and median survival time before and after PVS placement combined with¹²⁵ I particle chain or radiofrequency ablation catheter ablation for HCC patients with PVTT.The short-and long-term efficacy and safety of the approach;attempts to explore the best treatment options for different types of cancer thrombi.Methods: Retrospective analysis of 37 cases of HCC patients with PVTT treated in the Second Affiliated Hospital of Dalian Medical University from January 2014 toJanuary 2017,of which 20 patients were treated with¹²⁵ I particle chain implantation?particle group?,and RF ablation catheter therapy?RF?Group)In 17 patients,both groups received sequential TACE therapy to control the tumor.As of December 2017,all patients underwent regular follow-ups to record the surgical conditions,adverse reactions,liver function,blood tests,AFP changes,ultrasound,CT,or MRI findings of the two groups of patients,and to assess portal vein recanalization using the m RECIST evaluation criteria.The Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.Results:1.The median survival time of patients in the particle and radiofrequency groups was 12.5 months and 9.7 months?P>0.05?.After 3,6,9,12,and 15 months after surgery,the cumulative survival rates of the particle and radiofrequency groups were100%,85%,75%,55%,15%,and 100%,76.4%,47.1%,and 29.4%,respectively.11.8%.Subgroup analysis: The median survival time of patients with type II PVTT in particle group and radiofrequency group were 14.7 months and 13.2 months?P>0.05?;The median survival time of patients with type ? PVTT in particle group and radiofrequency group was 11.9months and 8.5months?P<0.05?.2.The total effective rate?RR?was 80% in the particle group and 52.9% in the radiofrequency group?P>0.05?;the disease control rate?DCR?was 90% and 82.4%,respectively?P>0.05?.Subgroup analysis: RR and DCR of type II PVTT were all 100%?P>0.05?.DCR of type ? PVTT was 86.7% and 75%?P>0.05?.RR of type ? PVTT was 73.3% and 33.3 %,respectively.?P < 0.05?.3.Preoperative and postoperative portal vein trunk pressure: The average particle group was?38.5±5.2?cm water column and?22±4.9?cm water column;the radiofrequency group was?37.8±5.4?cm water column,?20±5.1?cm Water column.4.There was no significant difference in the incidence of nausea,vomiting,liver pain,diarrhea,constipation,and myelosuppression between the particle group and the radiofrequency group?P>0.05?.5.The preoperative and postoperative particle and radiofrequency groups:AFP?IU/ml?were 536.8 ± 356.4,305.0 ± 273.2 and 542.9 ± 469.4,320.1 ± 298.2,respectively,and the reduction ratios were 0.44±0.41,0.35±0.39?P>0.05?.alanine aminotransferase?ALT??U /L?: 62.9±25.7,43.2±20.2 and 58.2±19.7,43.7±21.2,and the reduction ratios were: 0.30±0.29,0.27±0.18?P>0.05?;Albumin?ALB??g/L?was 31.2±4.5,35.5±4.5 and 31.8±5.2,34.7±3.5,and the increase ratios were: 0.42±0.15,0.37±0.11?P>0.05?;total bilirubin?TB??umol/l?: 27.6±3.4,23.0±4.5,and26.2±3.3,22.5±3.8,and the reduction ratios were: 0.31±0.25,0.24±0.23?P>0.05?.Conclusion: 1.PVS combined with¹²⁵ I particle chain or radiofrequency ablation catheter ablation sequential TACE for HCC patients with PVTT is safe and feasible,the incidence of complications is low,can control tumor progression,significantly prolong the survival of patients.2.For patients with type ? PVTT,we recommend PVS combined with125 I particle chain treatment.