Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
Department of Interventional Radiology, Baoan District People's Hospital of Shenzhen; Shenzhen, Guangdong Province, China.
J Cancer Res Ther. 2022 Apr;18(2):345-351. doi: 10.4103/jcrt.jcrt_1078_21.
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the sixth most prevalent malignancy worldwide. The incidence of portal vein tumor thrombosis (PVTT) is recorded as high as 10%-60% in HCC patients. The purpose of this study was to assess the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients complicated with PVTT in the main trunk.
A total of 33 HCC patients were treated with TACE + HAIC or TACE, respectively. The primary endpoint was overall survival (OS), while the secondary endpoints included progression-free survival, objective response rate (ORR), and disease control rate (DCR) of HCC lesions and PVTT in the trunk. Adverse events and main complications were also investigated. A COX model was used to identify the risk factors associated with OS.
There were 16 patients receiving TACE + HAIC and 17 receiving TACE. The median OS was longer in the TACE + HAIC group than the TACE group (P < 0.05). There were no significant differences in the ORR and DCR of HCC lesions and PVTT response between the two groups (P > 0.05). Alpha-fetoprotein was <400 ng/ml. Multivariate analysis showed that cavernous transformation of portal vein was associated with longer OS. In terms of complications, the addition of HAIC showed more myelosuppression than the TACE alone group (P < 0.05).
Compared with TACE alone, HAIC + TACE may be more safe and provide more benefits for HCC patients complicated with PVTT in the trunk.
肝细胞癌（HCC）是最常见的原发性肝癌，也是全球第六大常见恶性肿瘤。在 HCC 患者中，门静脉癌栓（PVTT）的发生率高达 10%-60%。本研究旨在评估经导管动脉化疗栓塞（TACE）联合肝动脉灌注化疗（HAIC）治疗主干型 PVTT 合并 HCC 的疗效和安全性。
共 33 例 HCC 患者分别接受 TACE+HAIC 或 TACE 治疗。主要终点为总生存期（OS），次要终点包括无进展生存期、HCC 病变和主干型 PVTT 的客观缓解率（ORR）和疾病控制率（DCR）。还调查了不良事件和主要并发症。采用 COX 模型识别与 OS 相关的风险因素。
有 16 例患者接受 TACE+HAIC，17 例患者接受 TACE。TACE+HAIC 组的中位 OS 长于 TACE 组（P<0.05）。两组 HCC 病变和 PVTT 反应的 ORR 和 DCR 无显著差异（P>0.05）。甲胎蛋白（AFP）<400ng/ml。多因素分析显示，门静脉海绵样变性与 OS 延长有关。在并发症方面，HAIC 加用比 TACE 单药组更易发生骨髓抑制（P<0.05）。
与 TACE 单药相比，HAIC+TACE 可能更安全，并为合并主干型 PVTT 的 HCC 患者带来更多获益。
