血管内近距离放射治疗联合经动脉化疗栓塞治疗 III 型或 IV 型门静脉癌栓肝癌患者的疗效和安全性。
Efficacy and safety of endovascular brachytherapy combined with transarterial chemoembolization for the treatment of hepatocellular carcinoma patients with type III or IV portal vein tumor thrombosis.
机构信息
Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.
The First affiliated hospital of Fujian Medical University, Fuzhou, 350025, China.
出版信息
World J Surg Oncol. 2022 Feb 2;20(1):30. doi: 10.1186/s12957-022-02495-4.
BACKGROUND
The purpose of this study was to evaluate the efficacy and safety of endovascular brachytherapy (EVBT) combined with transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) complicated with type III OR IV portal vein tumor thrombosis (PVTT) and to further analyze the prognostic predictors for the patients with HCC and PVTT.
METHODS
We retrospectively analyzed the medical records of 54 patients who were diagnosed with HCC complicated with type III or IV PVTT and received EVBT combined with modified TACE treatment from January 2017 to June 2019. Adverse events, treatment response, overall survival (OS), progression-free survival (PFS), and stent patency were analysed to evaluate the efficacy and safety of this treatment. The independent prognostic predictors of OS were also statistically analyzed by the cox regression model.
RESULTS
No adverse events occurred in the enrolled patients receiving EVBT combined with TACE treatment. The objective response and disease control rates were 42.6% and 96.3% respectively within 4 weeks after the treatment. The median OS and PFS were 209 days and 138 days, respectively. Cumulative stent patency rate was 70.4% at the last follow-up. AFP ≥ 400 ng/ml, ECOG PS > 1, Child Pugh grade B, and non-hemihepatic HCC were independent risk predictors to evaluate the OS of HCC patient with type III or IV PVTT.
CONCLUSIONS
EVBT combined with TACE was a relatively effective and safe strategy to treat HCC patients with type III or IV PVTT.
背景
本研究旨在评估血管内近距离放射治疗（EVBT）联合经动脉化疗栓塞（TACE）治疗合并 III 型或 IV 型门静脉癌栓（PVTT）的肝细胞癌（HCC）的疗效和安全性，并进一步分析此类 HCC 合并 PVTT 患者的预后预测因子。
方法
我们回顾性分析了 2017 年 1 月至 2019 年 6 月期间 54 例接受 EVBT 联合改良 TACE 治疗的 III 型或 IV 型 HCC 合并 PVTT 患者的病历。分析不良反应、治疗反应、总生存期（OS）、无进展生存期（PFS）和支架通畅率，以评估该治疗方法的疗效和安全性。采用 COX 回归模型对 OS 的独立预后预测因子进行统计学分析。
结果
接受 EVBT 联合 TACE 治疗的患者均未发生不良事件。治疗后 4 周内，客观缓解率和疾病控制率分别为 42.6%和 96.3%。中位 OS 和 PFS 分别为 209 天和 138 天。末次随访时，支架通畅率为 70.4%。AFP≥400ng/ml、ECOG PS＞1、Child Pugh 分级 B 和非半肝 HCC 是评估 III 型或 IV 型 PVTT 合并 HCC 患者 OS 的独立危险因素。
结论
EVBT 联合 TACE 是治疗 III 型或 IV 型 HCC 合并 PVTT 的一种相对有效和安全的策略。
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