Zhao Xiao-Hui, Yuan Hang, Xia Wei-Li, Zhang Li-Lin, Li Zhen, Cao Guang-Shao, Li Hai-Liang, Fan Wei-Jun, Li Hong-Le, Guo Chen-Yang, Yao Quan-Jun, Zhu Wen-Bo, Hu Hong-Tao
Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Yangtze University Health Science Center, Jingzhou, China.
Front Oncol. 2022 Oct 5;12:977462. doi: 10.3389/fonc.2022.977462. eCollection 2022.
To compare the efficacy of TACE combined with sorafenib and TACE combined with I seed implantation in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) combined with arterioportal fistulas (APFs), and discuss the efficacy and safety of TACE combined with I seed implantation.
Between January 2017 and December 2018, the clinical data of patients with HCC complicated with PVTT and APFs who were admitted to the Affiliated Cancer Hospital of Zhengzhou University, First Affiliated Hospital of Zhengzhou University, and Henan Provincial People's Hospital were prospectively collected. The patients were divided into the TACE+sorafenib (TACE-S) group based on their treatment willingness. There were 26 and 32 patients in the TACE-S and TACE-I groups, respectively. Both groups of patients underwent APFs occlusion during TACE therapy. The embolization effect of APFs was observed and recorded in the two groups, the efficacy of intrahepatic lesions and PVTT was evaluated, and the effects of different treatment methods on the efficacy were analysed.
All patients completed the 3 months follow-up. The improvement rates of APFs in TACE-S and TACE-I groups were 30.77% (8/26) and 68.75% (22/32), respectively, and difference was statistically significant (χ2 = 8.287, P=0.004). The median survival time of TACE-S and TACE-I groups was 8.00 months and 12.8 months, respectively (χ2 = 7.106, P=0.008). Multivariate analysis showed that the PVTT subtype (IIa/IIb) and treatment method (TACE-S or TACE-I) were independent factors affecting the recanalization of APFs in patients (P<0.05).
For patients with HCC with PVTT and APFs, TACE combined with I seed implantation can effectively treat portal vein tumor thrombus, thereby reducing the recanalization of APFs and prolonging the survival time of patients.
比较经动脉化疗栓塞术（TACE）联合索拉非尼与TACE联合碘粒子植入治疗伴有门静脉癌栓（PVTT）及动门静脉瘘（APF）的肝细胞癌（HCC）的疗效，并探讨TACE联合碘粒子植入的疗效及安全性。
前瞻性收集2017年1月至2018年12月在郑州大学附属肿瘤医院、郑州大学第一附属医院及河南省人民医院收治的HCC合并PVTT及APF患者的临床资料。根据患者的治疗意愿将患者分为TACE+索拉非尼（TACE-S）组。TACE-S组和TACE-I组分别有26例和32例患者。两组患者在TACE治疗期间均行APF封堵术。观察并记录两组APF的栓塞效果，评估肝内病灶及PVTT的疗效，分析不同治疗方法对疗效的影响。
所有患者均完成3个月随访。TACE-S组和TACE-I组APF的改善率分别为30.77%（8/26）和68.75%（22/32），差异有统计学意义（χ2 = 8.287，P = 0.004）。TACE-S组和TACE-I组的中位生存时间分别为8.00个月和12.8个月（χ2 = 7.106，P = 0.008）。多因素分析显示，PVTT亚型（IIa/IIb）及治疗方法（TACE-S或TACE-I）是影响患者APF再通的独立因素（P < 0.05）。
对于伴有PVTT及APF的HCC患者，TACE联合碘粒子植入可有效治疗门静脉癌栓，从而减少APF的再通，延长患者生存时间。
