| Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with intra-portal vein 125 I particles and stent implantation in treatment of hepatocellular carcinoma complicated by portal vein tumor thrombus,and to analyze the factors predicting the outcome of such patients.Methods From September 2014 to September 2017,the clinical data of 46 patients with HCC complicated by PVTT in interventional department of Anhui Provincial Hospital and Navy Anqing Hospital were analyzed retrospectively.The subjects in accordance with the criteria were randomly divided into two groups: the study group(n = 23)was treated with TACE combined with intra-portal vein stent and 125 I particles implantation;The control group(23 cases)was treated with TACE alone.According to the international standard of radioactive particles implantation,the two groups were followed up for 2 months,4 months,6 months,12 months,18 months and 24 months after operation.The evaluation of postoperative efficacy was based on the evaluation criteria of m RECIST solid tumor;The adverse reactions were evaluated with reference to the National Cancer Institute's general toxicity evaluation standard(NCI-CTC 3.0),and the incidence of adverse events,upper gastrointestinal bleeding,portal vein recanalization,peritoneal effusion and so on were recorded between the two groups.The total survival time and survival rate of the two groups were calculated by kaplan-meier method.The difference between the two groups was compared by log-rank test and the prognostic factors were analyzed.Results The average overall survival time and median overall survival time of the patients in the study group was13.24±0.94m?14.8m,and the 2-month,the 4-month,the 6-month,the 12-month,the 18-month,and the 24-month survival ratewere 100%,87.0%,8.0%,25.0%,and6.3% respectively.The average overall survival time and median overall survival time of the patients in the control group was 8.15±0.94 m,?7.8m,and the 2-month,the 4-month,the 6-month,the 12-month,the 18-month,and the 24-month survival rate were 100%,78.3%,60.3%,13.9%,0 and 0 respectively.With regard to the therapeutic response,no patients garnered CR,but 8,6 and 9 patients harvested PR,SD and PD respectively.The objective response rate(ORR)(CR+PR)/(CR+PR+PD+SD)was 34.78 % and the disease control rate(DCR)(CR+PR+SD)/(CR+PR+PD+SD)was 60.87%;and 0 cases of complete response,1 cases of partial response,4 cases of stable disease and 18 cases of progressive disease in the study group.The ORR was 4.35 and the DCR was 21.74.There was no significant difference in the incidence of adverse events between the two groups(P > 0.05).The rate of portal vein patency,ascites and upper gastrointestinal bleeding was significantly lower in the study group than that in the control group(P<0.05).In this study,all factors affecting prognosis were introduced into COX model analysis.It was found that patients with TACE alone,history of hepatitis B and patients with degree of portal vein stenosis was more than 50% had a short survival time,which was an important factor affecting the prognosis of patients.Conclusion 1.Transcatheter arterial chemoembolization combined with intraportal 125 I particles and stent implantation is a safe and effective method for the treatment of HCC with MPVTT;2.Transcatheter arterial chemoembolization combined with intraportal 125 I particles and stent implantation can significantly prolong the survival time of patients compared with TACE alone;3.Transcatheter arterial chemoembolization combined with intraportal 125 I particles and stent implantation can recanalize portal vein partially,descend the risk of gastrointestinal bleeding,reduce ascites and improve the quality of life of end-stage patients;4.Treatment,history of hepatitis B and degree of portal vein stenosis are important factors influencing prognosis. |
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