Purpose

To compare the clinical outcomes of portal vein irradiation stent implantation (PVIS) plus transcatheter arterial chemoembolization (TACE) and radiotherapy (RT) plus TACE in hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT).

Methods

Data from 79 patients with HCC complicated by PVTT treated with PVIS implantation plus TACE (n = 53) or treated with RT plus TACE (n = 26) were retrospectively analysed. The primary outcome measure was overall survival, and the secondary outcome was the stent patency period. HCC response and complications were evaluated.

Results

At a median follow-up of 14.3 (range, 1.2 ~ 60) months, the median OS was 13.1 (95% CI: 9.8 ~ 16.4) months in the PVIS plus TACE group compared to 8.0 (95% CI: 6.1 ~ 9.9) months in the RT plus TACE group (p = 0.021). Stent occlusion was observed in 11 patients with a median patency time of 8.5 (range, 2 ~ 22) months. Multivariate Cox regression analysis demonstrated that Vp4 PVTT (HR: 5.22; 95% CI: 1.74–15.74) and poor response to therapy (HR: 4.89; 95% CI: 2.66–8.99) were independent risk factors for OS, whereas PVIS plus TACE treatment (HR: 0.32; 95% CI: 0.18–0.56) was related to better prognosis. None of the patients in the two groups had grade 3–4 complications.

Conclusion

In conclusion, this retrospective study shows that PVIS plus TACE provides a significantly better survival outcome than RT plus TACE for HCC patients with PVTT.

中文翻译：

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门静脉照射支架加化疗栓塞与外放疗加化疗栓塞治疗合并门静脉癌栓的肝细胞癌的回顾性研究

目的

比较门静脉放疗支架植入术（PVIS）加经导管动脉化疗栓塞术（TACE）和放疗（RT）加TACE治疗合并门静脉癌栓（PVTT）的肝细胞癌（HCC）的临床疗效。

方法

对 79 例接受 PVIS 植入加 TACE 治疗（n  = 53）或接受放疗加 TACE 治疗（n  = 26）的PVTT 合并 HCC 患者的数据进行了回顾性分析。主要结果指标是总生存期，次要结果是支架通畅期。评估了 HCC 反应和并发症。

结果

在中位随访 14.3（范围，1.2 ~ 60）个月时，PVIS 加 TACE 组的中位 OS 为 13.1（95% CI：9.8 ~ 16.4）个月，而 PVIS 加 TACE 组为 8.0（95% CI：6.1 ~ 9.9） RT 加 TACE 组 ( p  = 0.021)。在 11 名患者中观察到支架闭塞，中位通畅时间为 8.5（范围，2~22）个月。多变量 Cox 回归分析表明 Vp4 PVTT（HR：5.22；95% CI：1.74-15.74）和对治疗的不良反应（HR：4.89；95% CI：2.66-8.99）是 OS 的独立危险因素，而 PVIS 加 TACE治疗（HR：0.32；95% CI：0.18-0.56）与更好的预后相关。两组患者均未出现 3-4 级并发症。

结论

总之，这项回顾性研究表明，对于 PVTT 的 HCC 患者，PVIS 加 TACE 的生存结果明显优于 RT 加 TACE。