Efficacy And Survival Analysis Of Iodine-125 Seed Placement Combined With Transcatheter Arterial Chemoembolization For The Treatment Of Hepatocellular Cacinoma With Portal Vein Tumor Thrombus

Objective:At present,there is no international consensus on the diagnosis and treatment of hepatocellular cacinoma(HCC)with portal vein tumor thrombus(PVTT).This article is aimed to research the short-term and long-term efficacy of iodine-125 seed placement combined with transcatheter arterial chemoembolization(TACE)in treating HCC with type?or type?PVTT,and to investigate the survival benefits variation of different types of PVTT after the treatment.Methods:A total of 80 patients diagnosed as HCC combined with PVTT in the First Affiliated Hospital of China Medical University from Jan.1st,2013 to Dec.31st,2017undergo a retrospective study.41 of who received the placement of iodine-125 seed combined with TACE were called the combined group,and the rest 39 patients who received TACE only were called the simple group.Compared with the shout-term effect1 month after operation and the OS of two groups,and took multiple-factor analysis of the influence factors of the differences of OS.And then,compared with the survival benefits of patients with different types PVTT.Results:One month after the operation,the PVTT response rate(RR)of the combined group is 43.8%(18/41)and that of the simple group is 6.9%(2/29).The difference was statistically significant,?~2=9.657,P=0.002.OS of the combined group and the simple group were 13.25 months and 8.26 months,respectively.The median survival time of the two groups were 11 months and 6 months,respectively.The difference was statistically significant,?~2=9.235,P=0.002.Type?PVTT(HR=1.840,95%CI=1.097~3.085,P=0.021)and non-metastasis(HR=0.346,95%CI=0.133~0.900,P=0.030)were the relative independent factors for OS.Among the type?PVTT patients,OS of the combined group and the simple group were 13.61 months and 10.24 months,respectively.The median survival time of the two groups were 12 months and 7 months,respectively.The difference was not statistically significant,?~2=1.275,P=0.259.While among the type?PVTT patients,OS of the two groups were 12.60 months and 5.94months,respectively.The median survival time of the two groups were 11 months and 5months,respectively.The difference was statistically significant,?~2=16.937,P<0.001.Conclusions:The placement of iodine-125 seed combined with TACE treating HCC with PVTT is a safe and effective therapeutic schedule,which could improve the short-term effect and prolong the OS of the patients of terminal HCC.Patients with type?PVTT could acquire longer survival benefits by receiving TACE and stenting combined with iodine-125 seed strands than patients with type?PVTT.