Efficacy And Prognostic Factors Of Transarterial Chemoembolization Combined With ¹²⁵iodine Implantation In The Treatment Of Stage ?a Hepatocellular Carcinoma With Type ? Tumor Thrombus

Background and Objective:Hepatocellular carcinoma?HCC?is one of the most common malignant tumors in the world.It is easy to invade the portal vein and form a portal vein tumor thrombus?PVTT?.There are many liver cancer staging standards in the world,and the National Health and Family Planning Commission of China had published the“Code for the diagnosis and treatment of primary liver cancer”?2017?that is more suitable for China's national conditions.The classification criteria for commonly used tumor thrombus in China are based on the anatomical location of the tumor thrombus.The effectiveness of TACE combined with ¹²⁵I seed implantation in the treatment of liver cancer with portal vein tumor thrombus has been confirmed by many literatures.Based on the Chinese staging criteria of liver cancer and the classification criteria of tumor thrombus,the study explored the efficacy of TACE combined with 125I seed implantation in the treatment of stage IIIa hepatocellular carcinoma with type II tumor thrombus.And the factors affecting the prognosis were analyzed.Material and Methods:Patients who were diagnosed with stage IIIa hepatocellular carcinoma with type II tumor thrombus and who were treated with TACE combined with 125I seed implantation from January 2012 to December 2016 at the Affiliated Tumor Hospital of Zhengzhou University.A total of 116 patients were enrolled,and the clinical data of all enrolled patients were retrospectively analyzed.The postoperative complications and survival time of the patients were counted.Survival curves were plotted by Kaplan-Meier method,and the cumulative survival rate and median survival time of patients at 6 months,1 year,and 2 years were calculated,and prognostic factors affecting patient survival were analyzed.The 2-month efficacy after treatment was assessed using the mRECIST criteria.Result:The 6-month,1-year,and 2-year survival rates were 85.3%,58.6%,and 20.7%,respectively,and the median survival was 13.0 months.Univariate analysis showed that portal vein tumor thrombus subtype?IIa/IIb?,maximum tumor diameter??70/>70mm?,total tumor diameter??90/>90mm?,Child-Pugh grade?A/B?and AFP values??400/>400ng/ml?are the initial prognostic factor affecting the survival of patients?all P<0.05?.Multivariate analysis showed that portal vein tumor thrombus subtypes?IIa/IIb?and Child-Pugh grade?A/B?were independent prognostic factors affecting the survival of cancer patients?all P<0.05?.No serious complications occurred after treatment.Conclusion:TACE combined with ¹²⁵I seed implantation for the treatment of stage IIIa hepatocellular carcinoma with type II portal vein tumor thrombus can prolong survival,repeat treatment without serious complications.Multivariate analysis showed that the tumor thrombus subtype and liver function Child-Pugh classification were independent risk factors affecting the prognosis of patients.