门静脉125I粒子条联合肝动脉化疗栓塞治疗原发性肝癌合并门静脉癌栓的疗效

Therapeutic effect of transcatheter arterial chemoembolization combined with iodine-125 seed strand implantation for treating hepatocellular carcinoma with portal vein tumor thrombus

目的探讨门静脉125I粒子条联合肝动脉化疗栓塞(TACE)治疗原发性肝癌合并门静脉癌栓的疗效。方法回顾性分析2015年1月至2019年1月徐州医科大学附属医院介入放射科收治的80例肝癌合并门静脉癌栓患者资料,其中男性71例,女性9例,年龄(53.1±9.9)岁。80例患者中,48例接受单纯TACE(A组),32例行门静脉125I粒子联合TACE治疗(B组),对比两组患者的生存期及肝内病灶、癌栓控制率。结果32例患者均成功植入门静脉粒子及支架。癌栓控制率B组优于A组(90.6%比81.3%),两组差异有统计学意义(P<0.05)。两组患者肝内病灶控制率分别为77.1%(A组)、90.6%(B组),差异无统计学意义(P>0.05)。A、B两组患者生存期分别为(8.0±0.6)、(16.0±2.1)个月,中位生存期分别为(7.6±1.0)、(14.8±1.5)个月,B组均优于A组,差异均具有统计学意义(均P<0.05)。单因素及多因素分析显示肿瘤大小是影响预后的独立危险因素[回归系数:0.960,HR:0.383,95%CI:(0.158~0.926),P<0.05],125I联合TACE治疗为影响预后的保护性因素[回归系数:-1.525,HR:0.218,95%CI:(0.100~0.473),P<0.05]。结论对于肝癌合并门静脉癌栓的患者,相对于单纯TACE,TACE联合125I粒子条植入可对门静脉癌栓进行安全、有效的控制,延长患者生存期。

Objective To study the efficacy of combined transcatheter arterial chemoembolization(TACE)with iodine-125 seed implantation in treating hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT).Methods From January 2015 to January 2019,eighty patients with HCC and PVTT who were treated at Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.A total of 71 patients were male and 9 were female,aged(53.1±9.9)years.The patients included 48 patients(group A)who were treated with TACE alone and 32 patients(group B)with TACE combined with iodine-125 seed implantation.The survival time and disease control rate(DCR)of the intrahepatic lesions and PVTT in the two groups were compared.Results There were 32 patients who were successfully implanted with portal vein iodine-125 seed and stents.The DCR of PVTT in group B was significantly better than in group A(90.6%vs.81.3%,P<0.05).The DCR of the intrahepatic lesions in the two groups was 77.1%(group A)and 90.6%(group B).There was no significant difference between the two groups(P>0.05).The survival times of group A and group B were(8.0±0.6)and(16.0±2.1)months,respectively.The median survival times were(7.6±1.0)and(14.8±1.5)months respectively.Group B had significantly better survival time than Group A,(both P<0.05).Univariate and multivariate analysis showed that tumor size was an independent risk factor of prognosis(Regression coefficient:0.960,HR:0.383,95%CI:0.158-0.926,P<0.05).125I treatment was a protective factor of prognosis(Regression coefficient:-1.525,HR:0.218,95%CI:0.100-0.473,P<0.05).Conclusion For patients with HCC and PVTT,compared with TACE alone,TACE combined with iodine-125 seed implantation could safely and effectively control portal vein tumor thrombus,and prolonged patient survival.