TACE Combined With Portal Stent Placement And Iodine-125 Particle Strip Placement For The Treatment Of Primary Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis

Objective:To investigate the safety and efficacy of hepatic arterial infusion chemoembolization combined with portal stent placement and iodine-125 particle strip placement in patients with primary hepatocellular carcinoma combined with portal vein cancer.Methods : We retrospectively analyzed the data of 54 patients with PLC-associated PVTT who were admitted to hospital from March 2012 to June2016 in Guangxi Affiliated Cancer Hospital of Guangxi Medical University.All cases were diagnosed by clinical history,AFP,dynamic contrast-enhanced MRI,dynamic contrast-enhanced CT,Contrast-enhanced ultrasound and conventional MRI enhancement of the United States and other imaging or histological biopsy confirmed.Among them,18 patients underwent TACE combined with portal stenting and I125 particle strip placement as an experimental group.They were under the guidance of ultrasound and DSA for PVTT stent and I125 particle strips;36 patients underwent TACE alone.Control group.The short-term efficacy of the target lesions was assessed according to the latest mRECIST.Postoperative follow-up was 24 months.The long-term efficacy was evaluated based on the median overall survival.At the same time,the local control of PVTT,blood routine,liver function,adverse reactions and complications were observed.Results : Efficacy: 18 patients in the experimental group,0 complete remission(CR),9 partial remission(PR),7 stable disease(SD),2 disease progression(PD),and objective response rate(ORR)of 50.0%;There were 36 cases in the group,CR 0 cases,PR 11 cases,SD 15 cases,PD 10 cases,ORR30.1%;ORR difference between the two groups was statistically significant(P<0.05).The cumulative survival rates for the experimental group at 2,4,6,12,15,18,and 24 months were: 100.0%,100%,88.9%,38.9%,22.2%,11.1%,and0%;the control group 2,4,The cumulative survival rates at 6,12,15,18,and 24 months were: 100%,83.3%,66.4%,16.7%,8.3%,0%,and 0%.The recent survival rate of the experimental group was better than that of the pure TACE control group..The Kaplan-Meier method was used to evaluate the long-term efficacy.The results showed that the median OS of the experimental group and the control group was 11 months and 7 months respectively.The median OS of the experimental group was 4 months longer than that of the control group.The difference was statistically significant.(P=0.017<0.05).In the subgroup analysis of this study,subgroups of patients with Child-Pugh liver function grade A and B were performed separately.The liver function was Grade A: the median OS in the experimental group was approximately 11.7 months;the median OS in the control group At 9 months,the median OS in the liver function class A patients in the experimental group was significantly better than that in the control group,which was significantly longer in 2.7 months(P<0.05);the liver function was in the B class group: the median OS in the experimental group was approximatelyAt 6.9 months,the median OS of the control group was 5.5 months.The median OS of the experimental group was slightly better than that of the control group,and the difference was not statistically significant(P=0.059>0.05).No grade III-IV adverse reactions and surgically related deaths occurred in all patients.The correlation of postoperative indexes: There were significant differences between the two groups in liver function-related index levels,and the improvement of liver function-related indexes was better in the experimental group(P<0.05);nausea,vomiting,abdominal pain,diarrhea,constipation,etc.were observed before and after treatment.There was no significant difference in adverse reactions between the two groups(P>0.05).After treatment,the experimental group was able to significantly prolong the median patency of the portal vein compared with the control group.The number of cases with hepatic encephalopathy,severe infection,and upper gastrointestinal bleeding was significantly reduced.The ascites control rate and out-control rate were better than those of the control group.Statistical significance(P<0.05).Conclusion: TACE combined with portal stent placement and iodine-125 particle strip placement can prolong the survival of patients with primary hepatocellular carcinoma and portal vein tumor thrombus.