Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India.
Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India.
Indian J Cancer. 2022 Jul-Sep;59(3):325-329. doi: 10.4103/ijc.IJC_769_19.
Transarterial chemoembolization (TACE) is the preferred treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT). However, select patients with advanced HCC and with PVTT have shown improved survival with TACE. This study was undertaken to evaluate the outcome of TACE in patients with HCC beyond Barcelona-Clinic Liver Cancer- B (BCLC - B) and those with HCC and PVTT.
Patients with unresectable HCC, subjected to TACE were included. HCC patients with PVTT involving main portal vein and, poor performance status were excluded from the study. Patients were stratified according to performance status, alpha feto protein (AFP) values, and up-to-seven criteria. Individually and using various combinations, the influence of these variables on survival was also estimated.
A total of 50 patients were included in the study. PVTT was present in 12 patients. Clinically, significant liver failure was observed in two patients. The average overall survival of patients beyond BCLC-B following TACE was 13 months. Survival was not influenced by tumor invasion into the portal vein. Patients with higher AFP levels had comparable survival provided their tumor load was satisfying up-to-seven criteria.
We conclude that TACE could improve survival in selective HCC patients beyond BCLC-B and with PVTT not extending to the main portal vein.
经动脉化疗栓塞术（TACE）是无门静脉癌栓（PVTT）的中晚期肝细胞癌（HCC）患者的首选治疗方法。然而，一些晚期 HCC 伴 PVTT 患者接受 TACE 治疗后生存时间得到改善。本研究旨在评估 TACE 治疗巴塞罗那临床肝癌分期（BCLC）B 期以上 HCC 患者和伴有 PVTT 的 HCC 患者的疗效。
纳入接受不可切除 HCC 患者行 TACE 治疗。排除伴有主门静脉受累和较差的体能状态的 HCC 合并 PVTT 患者。根据体能状态、甲胎蛋白（AFP）值和 up-to-seven 标准进行分层。单独和使用各种组合，还估计了这些变量对生存的影响。
本研究共纳入 50 例患者。12 例患者存在 PVTT。2 例患者出现明显肝功能衰竭。TACE 后 BCLC-B 期以上 HCC 患者的平均总生存期为 13 个月。肿瘤侵犯门静脉不影响生存。AFP 水平较高的患者，如果肿瘤负荷符合 up-to-seven 标准，则生存时间相当。
我们得出结论，TACE 可以改善选择性 BCLC-B 期以上 HCC 患者和主门静脉未受累的 PVTT 患者的生存。
