Efficacy And Safety Of Radioactive Iodine-125 Seed Implantation In Abdominal Lymph Node Metastasis Of Hepatocellular Carcinoma

ObjectiveTo evaluate the efficacy and safety of radioactive iodine-125 seed implantation in abdominal lymph node metastasis of hepatocellular carcinoma and to analyze the prognostic factors influencing the survival.Materials and methods76 patients with advanced HCC and abdominal lymph node metastasis were retrospectively collected in our hospital from June 2018 to January 2022.There were 35patients received ¹²⁵I seed implantation in abdominal lymph node metastasis,and 41patients did not receive ¹²⁵I seed implantation or other local treatment in abdominal lymph node metastasis.During the follow-up period,laboratory tests and imaging examinations were performed every 4-6 weeks,and the efficacy of lymph node metastasis was evaluated according to RECIST criteria.The pain relief rate,objective response rate（ORR）,local tumor progression-free survival（LTPFS）and overall survival（OS）were compared between the two groups.The prognostic factors were analyzed.In the comparison of short-term curative efficacy,there were complete response（CR）,partial response（PR）,stable disease（SD）and progressive disease（PD）.For the analysis of lymph node response in the treatment group,Chi-square test was used to conduct univariate analysis on the basic clinical data of patients in the treatment group,and then the binary logistic regression model was used for multivariate analysis to determine the independent influencing factors of lymph node response in the treatment group.Kaplan-Meier method was used in local tumor progression-free survival and overall survival analysis.Log-rank test was used for univariate analysis.Cox proportional risk regression model was used for univariate analysis and multivariate analysis to determine the independent risk factors of LTPFS and OS.ResultsA total of 76 patients were included in this study.The 1,3,and 6-month of treatment group ORR were 40.0%,50.0%and 31.6%,respectively.The 1,3,and 6-month ORR of control group were 9.8%,5.0%and 0.0%.The difference in ORR between the two groups was statistically significant（P=0.002,P<0.001,P=0.003）.Maximum lymph node diameter≥2cm and the interval between confirmed lymph node metastasis and surgery≥2months were independent factors for lymph node response in the treatment group（P=0.049,P=0.017）.Compared with the pain alleviation of control group,the pain alleviation rate was 75.0%in treatment group,and 37.5%in control group.The difference was statistically significant（P=0.041）.By the end of follow-up,LTPFS of the treatment group was 12.2±1.4 months（95%CI:9.4-15.0 months）,and that of the control group was4.0±0.5 months（95%CI:3.1-4.9 months）,indicating a statistically significant difference between the two groups（P=0.004）.Maximum lymph node diameter≥2cm and multiple lymph nodes were independent risk factors of LTPFS in patients in the treatment group（P=0.008,P=0.031）.A total of 58 patients（76.3%）died,the total OS was 11.8±1.0 months（95%CI:9.9～13.7 months）.The OS of the treatment group was 14.3±1.8 months（95%CI:10.8～17.8 months）,and the OS of the control group was 9.3±1.5 months（95%CI:6.3～12.3 months）.The OS difference between the two groups was statistically significant（P=0.010）.Child-pugh grade B,no treatment for lymph node metastasis and portal vein tumor thrombus were independent factors for overall OS（P=0.018,P=0.025,P=0.001）.Portal vein tumor thrombus was the independent influencing factor of OS in patients in the treatment group（P=0.046）.The success rate of ¹²⁵I seed implantation was 100.0%.Postoperative mild pain at the puncture site was observed in 6 patients（17.1%）,fever was observed in 2 patients（5.7%）,and needle bleeding was observed in 4 patients（11.4%）.None of the patients had any radiation injury-related complications,such as bleeding,infection,pain and peripheral organ injury,during postoperative follow-up.Conclusion（1）The ORR of the treatment group was higher than that of the control group at 1,3and 6 months.Radioactive ¹²⁵I seed therapy for lymph node metastasis had significant short-term efficacy and could effectively palliate lymph node related pain.Maximum lymph node diameter≥2cm and the interval between confirmed lymph node metastasis and surgery≥2 months were independent factors for lymph node response in the treatment group.（2）On the survival benefit,OS and LTPFS of the treatment group were higher than those of the control group.Child-pugh grade B,no treatment for lymph node metastasis and portal vein tumor thrombus were independent factors for overall OS.In the treatment group,portal vein tumor thrombus was the independent influencing factor of OS,and maximum lymph node diameter≥2cm and multiple lymph nodes were independent risk factors of LTPFS.（3）The adverse reactions of radioactive ¹²⁵I seed implantation in the treatment of abdominal lymph node metastasis were slight and self-limited,and no severe radioactive damage occurred after the operation.Therefore,radioactive ¹²⁵I seed implantation is a safe and effective local treatment method.