| Objective: To compare the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with high intensity focused ultrasound(HIFU)versus TACE alone in the treatment of massive hepatocellular carcinoma(MHCC,≥5cm)with portal vein tumor thrombosis(PVTT),and analyze the prognostic factors of those patients.Methods: One hundred and eleven patients with MHCC with PVTT were enrolled in this retrospective study.They were divided into the TACE+HIFU group(56 patients received TACE combined with HIFU treatment)and the TACE group(55 patients only received TACE treatment).According to whether the feeding artery of PVTT was embolized during TACE,TACE+HIFU group was divided into two subgroups(A: 33patient’s feeding artery of PVTT was embolized during TACE;B:23patients without embolization the feeding artery of PVTT).TACE group was divided into two subgroups(C:29 patient’s feeding artery of PVTT was embolized during TACE;D:26 patients without embolization the feeding artery of PVTT).Tumor response according to m RECIST and adverse events were analyzed,the prognostic factors for overall survival(OS)were determined,karnofsky scores of the 4 groups were compared between preoperative and 1-month postoperative.Results: The median OS of the TACE+HIFU group was 12 months,which is more than TACE group(5 months,P=0.000).The median OS of subgroup A(12 months)is more than other subgroups(B:8 months,P=0.019;C:6 months,P=0.000;D:5 months,P=0.000).The TACE+HIFU group showed higher tumor response rates than the TACE group(ORR: 67.9% vs30.9%,P = 0.000;DCR: 91.1% vs 76.4%,P =0.036).The PVTT grades,lipiodol accumulation of PVTT and Therapeutic method were independent prognostic factor for OS.The Karnofsky score one month after treatment in the TACE+HIFU group(75(70,80))was higher than that in the TACE group(70(60,70),P=0.000).The postoperative Karnofsky score of subgroup A was better than subgroup C and D(P=0.003,0.003),but without statistically significant difference to compare with subgroup B(p=0.315).There were no serious complications in every subgroup within 1 month after operation.Conclusion: The pattern of TACE+HIFU is a safe and effective combination therapy for patients with MHCC with PVTT and worthy of clinical application,especially the therapy model of TACE(with target embolization for PVTT during TACE treatment)combined with HIFU.The PVTT grades,lipiodol accumulation of PVTT and therapeutic method are identified as significant independent prognostic factors in those patients. |
