ABSTRACT
Objective To assess the therapeutic effect and influencing factors of TACE for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).Methods Data of 685 patients with HCC and PVTT were retrospectively analyzed.There were 475 patients treated with TACE (TACE group) and 210 patients treated with supportive treatment (supportive treatment group).The survival time of two groups were observed and compared.The multivariate Cox regression analysis was used to analyze the prognostic factors.Results The median survival time of all 685 patients was 6.3 months.The median survival time of patients in TACE group and supportive treatment group was 7.1 months and 5.2 months,respectively (P=0.002).The 6-,12-and 24-month survival rates were 57.30％,27.30％ and 12.10％ in TACE group,and 37.90％,12.20％ and 3.10％ in supportive treatment group,respectively.Univariate analysis showed that the Child-Pugh classification,the diameter of lesion,gamma-glutamyl transferase level and type of PVTT might be significant prognostic factors for overall survival.Multivariate Cox proportional hazard model analysis showed the Child-Pugh classification and type of PVTT were independent prognostic factors for overall survival.Further analysis showed that the median survival time of patients with type Ⅰ or Ⅱ PVTT in TACE group was 7.8 months,and that in supportive treatment group was 5.5 months.There were statistical differences of 6-,12-and 24-month cumulative survival rate between the 2 groups (P =0.001).The median survival time of patients with type Ⅲ or Ⅳ PVTT in TACE group was 5.3 months,and that in supportive treatment group was 4.5 months.There was no statistical difference of the 6-,12-and 24-month cumulative survival rate between the 2 groups (P=0.662).Conclusion TACE is effective in the treatment of HCC with PVTT.The major influencing factors for survival time of patients with HCC and PVTT are Child-Pugh classification and type of PVTT.The effect of TACE for HCC patients with type Ⅲ or Ⅳ PVTT is unsatisfied.
ABSTRACT
Objective To explore the expression of vascular endothelial growth factor (VEGF) and apoptosis of the tumor cells in the different regions of rabbit liver VX2 tumor after radiofrequency ablation (RFA).Methods Forty-eight experimental rabbits were implanted with VX2 tumor.After successfully established the model,the rabbits were randomly divided into control group (n=6) and RFA group (n=42).In the RFA group,7 rabbits at each time point were killed at immediately,1 day,2 days,1 week,2 weeks,3 weeks after RFA,and the tumor specimens were retained and performed with HE staining,VEGF,Annexin V-FITC/PI labeling,flow cytometry analysis.The changes of VEGF and apoptosis of the cells in different periods and different zones after RFA were observed.Results After the operation,the difference of the VEGF value of the needle zone,coagulation necrotic zone and junction zone had statistically significant (all P＜0.05).The difference of the VEGF value in each zone between immediately and the other time points after operation by pairwise comparisons were significantly different (all P＜0.05).The VEGF value of the needle zone and coagulation necrotic zone reached the peak after operation immediately,which declined from 1 day to 3 weeks after operative.And VEGF of the junction zone increased from immediately to 1 week after operation,and declined 2 weeks after operation.There were significant differences in the apoptosis rate of the three zones after RFA compared with control group (all P＜0.05).The apoptosis rate in all zones were at the peak on the 1 day after operation,and then showed a downward trend.Conclusion The reduction of VEGF and apoptosis of tumor cells in the needle zone and coagulation necrotic zone are significant,but tumor remnant remains visible in the junction zone.In the third week after RFA,the proliferation of the remaining tumor cells can be recurrent to preoperative levels,which suggests that the further treatment should be performed at this period.