Clinical Study Of Ginsenoside Rg3 In Prevention Of Recurrence And Metastasis After Primary Hepatocellular Carcinoma With Portal Vein Thrombosis

Objective Portal vein tumor thrombosis(PVTT)is an important complication of advanced liver cancer.It is usually found that PVTT is regarded as a end stage of tumor,routine treatment as transcatheter arterial chemoembolisation(TACE)and other treatments,the survival time is only 6 months.We underwent TACE,three dimensional conformal radiotherapy(3D-CRT),selective portal vein embolization(PVE)after primary PVAT in patients with PVTT Line surgery has achieved a certain effect,but the recurrence rate is still high,oral sorafenib can reduce the recurrence,but this therapeutic protocol is limited by high price and not covering by medical insurance.Previous studies have shown that Rg3 isolated from traditional Chinese medicine ginseng,induced tumor cell apoptosis,inhibition of tumor cell proliferation,invasion,metastasis and tumor angiogenesis,which was considered as novel path to inhibit the recurrence and metastasis of liver cancer after surgery.In this study,patients with hepatocellular carcinoma with PVTT were treated with ginsenoside Rg3,and the recurrence of tumor and the long-term survival time were observed.The clinical experience of patients with hepatocellular carcinoma combined with PVTT was analyzed.Methods Analysis of September 2015 to September 2016 in Zhejiang Province People’s Hospital and Shanghai Oriental Hepatobiliary Surgery Hospital to meet the inclusion criteria and conduct of TACE,3D-CRT,PVE,and then follow by the planed operation of 64 cases,including TACE after resection of hepatocellular carcinoma in 45 cases,TACE + 3D-CRT + liver cancer resection in 13 cases,TACE + 3D-CRT +selective portal vein embolization and portal vein resection of hepatocellular carcinoma resection in 6 cases.Overall 64 patients were randomly divided into two groups,named Rg3 group with 31 cases and sorafenib group with 33 cases retrospectively.we compared tumor-free survival rate and overall survival rate between the two groups.Also,we compared the symptomatic scoring of Traditional Chinese Medicine between two groups preoperatively and postoperatively three months.Results Until June 2017,a total of 64 cases were followed up,5 cases were lost,the follow-up rate was 92.2%;the current surviving 22 people,37 cases died;Rg3 group of 31 people,33 people in the sorafenib group.1.TACE + surgery:22 patients in Rg3 group,and 23 patients in sorafenib group;sorafenib group 1 case taking 3 months due to abnormal liver function,1 case abandon due to severe skin rash after administrating 6 months;there are 2 patients losses in 5 months after follow-up,and 1 patient losses in 8 months after follow-up in Rg3 group,retrospectively;1 case is follow up for 4 months in sorafenib group.The median survival time was 9 months and 10 months,P value is 0.997,median survival time is 12 and 14 months,P value is 0.043.2.TACE + 3D-CRT +surgery:6 patients in Rg3 group,7 patients in sorafenib group;Rg3 group 1 case taking 5 months after abnormal liver function disabled,sorafenib group 1 case taking 6 months due to abnormal liver function;Rg3 group 1 case lose in 3 months after follow-up.The median survival time is 5 months and 5 months,P value is 0.82,median survival time is 10 and 11 months,P value is 0.009.3.TACE + 3D-CRT + PVE +surgery:3 patients in the Rg3 group and 3 patients in the sorafenib group.The median survival time is 3 months and 4 months respectively.The P value is0.564.Survival time is 7 and 5 months,P value is 0.083.4.Overall survival:31 patients in Rg3 group,33 patients in the sorafenib group,postoperative tumor-free median survival time is 8 months and 9 months,P value of 0.883;postoperative median survival time 12 Month and 14 months,P value of 0.023.5.TCM syndrome score quantification score evaluation:before and after oral administration of Chinese medicine after 3 months of quantitative score of the points were calculated,markedly for the sorafenib group 13 cases,Rg3 group 10 cases;effective for 10 cases of sorafenib group,15 cases of Rg3 group;4 cases of sorafenib group,6 cases of Rg3 group;P value of 0.683.Conclusions Effects of ginsenoside Rg3 on anti-tumor therapy for patients with Hepatocellular carcinoma combined with Portal vein tumor thrombus after surgical treatment:there was no statistical difference between postoperative tumor-free survival time;there were statistical difference in the period of administration of ginsenoside Rg3 after tumor recurrence,which indicates that the anti-tumor effect was weaker than sorafenib.Therefore,liver cancer with portal vein tumor thrombus patients after the second stage of surgery,it is a good choice to administration ginsenoside Rg3 for the patients who can not afford sorafenib.