血管内近程放疗联合支架植入及经动脉化疗栓塞治疗肝细胞肝癌合并门脉主干癌栓

Endovascular brachytherapy combined with stent placement and transarterial chemoembolization for treatment of hepatocellular carcinoma with main portal vein tumor thrombus

目的评价血管内近程放疗(endovascular brachytherapy,EVBT)联合支架植入及经动脉化疗栓塞(transarterial chemoembolization,TACE)治疗肝细胞肝癌(hepatocelluar carcinoma,HCC)合并门脉主干癌栓(main portal vein tumor thrombus,MPVTT)的安全性及疗效。方法对2009年1月至2014年12月在复旦大学附属中山医院接受支架植入及TACE治疗的289例HCC合并MPVTT患者的病例资料进行回顾性分析,其中194例(研究组)同期在门脉主干内植入碘-125粒子条,余95例未接受EVBT的患者作为对照组。对两组患者的生存期、无疾病进展生存期、支架通畅期及治疗相关不良事件的发生率进行比较。结果所有碘-125粒子条及支架均准确植入门脉主干梗阻段,无严重治疗相关不良事件发生。平均随访(10.1±5.2)个月,研究组及对照组的中位生存期分别为(9.3±1.1)及(4.9±0.5)个月(P<0.001),中位无疾病进展生存期分别为(6.0±0.3)及(3.0±0.1)个月(P<0.001),中位支架通畅期分别为(11.0±1.1)及(4.8±0.3)个月(P<0.001)。结论血管内EVBT联合支架植入及TACE治疗HCC合并MPVTT安全、有效。

Objective To evaluate the safety and efficacy of endovascular implantation of iondine-125（125I）seeds strand and stent combined with transarterial chemoembolization（TACE）to treat hepatocellular carcinoma（HCC）with main portal vein（MPV）tumor thrombus（MPVTT）. Methods Data on treatment with intra-portal vein stent placement and TACE in 289 consecutive HCC patients with MPVTT,from Jan.,2009 to Dec.,2014 in Zhongshan Hospital of Fudan University were analyzed retrospectively.Synchronal implantation of 125 I seeds strand in MPV was performed in 194patients（study group）.The remaining 95 patients who refused endovascular brachytherapy served as control（control group）.The overall survival,free of disease progression survival,stent patency period and procedure-related adverse events were compared between the two groups. Results All 125 I seeds strand and stent were implanted in obstructed MPV correctly without serious procedurerelated adverse events.During a mean of（10.1±5.2）months＇ follow-up,the median survival was（9.3±1.1）months in study group,while it was（4.9±0.5）months in control group,respectively（P〈0.001）.Median free of disease progression survival in study and control group was（6.0±0.3）months and（3.0±0.1）months（P〈0.001）.Median stent patency period was（11.0±1.1）months in study group and（4.8±0.3）months in control group,respectively（P〈0.001）. Conclusions These findings suggested that endovascular implantation of 125 I seeds strand and stent combined with TACE was potentially a safe and effective treatment option for patients with HCC and MPVTT.