Research progress on the formation mechanism of hepatocellular carcinoma with portal vein tumor thrombus / 中华肝胆外科杂志

Hepatocellular carcinoma is a common malignant disease in clinical practice, and portal vein tumor thrombosis (PVTT) is one of the important factors affecting the prognosis of hepatocellular carcinoma. PVTT has strong oncologic characteristics and is highly susceptible to extrahepatic metastasis, complicating portal hypertension, leading to gastrointestinal bleeding or liver failure and causing death. In this paper, we review the formation mechanism of hepatocellular carcinoma combined with PVTT in terms of local anatomy, hemodynamics, molecular biology and tumor microenvironment to provide effective reference for clinical treatment.

Progress and strategies of surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus / 中华消化外科杂志

The incidence of portal vein tumor thrombus (PVTT) in patients with hepato-cellular carcinoma (HCC) is high and the prognosis is poor. The treatment mode of HCC+PVTT is changing to multidisciplinary comprehensive treatment. The authors make a deep investigation on the occurrence basis, classification, surgical treatment indication, postoperative adjuvant treatment and preoperative conversion treatment plan of HCC+PVTT, in order to provide reference for the diagnosis and treatment of this disease.

Diagnostic value of endoscopic ultrasound-guided fine needle aspiration for portal vein tumor thrombus (with video) / 中华消化内镜杂志

To evaluate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for portal vein tumor thrombus, data of patients with digestive system malignant tumors combined with portal vein tumor thrombus diagnosed by CT or magnetic resonance imaging who underwent EUS-FNA from April 2015 to July 2020 in the Second Affiliated Hospital of Soochow University were collected. A total of 7 patients were included, with 2 cases of primary hepatocellular carcinoma, 3 cases of primary pancreatic carcinoma and 2 cases of primary gastric cancer. EUS-FNA was successfully performed in 7 patients with portal vein embolus. Pathological examination of portal vein embolus showed 5 cases of malignant tumor. No tumor cell was found in 2 cases. There were no complications such as local hematoma, abdominal hemorrhage or infection in all patients. EUS-FNA is safe and effective for patients diagnosed as having malignant tumors with portal vein embolus.

Influential factors of stereotactic radiotherapy for primary liver cancer / 中国基层医药

Objective:To investigate the factors affecting the therapeutic effects of stereotactic radiotherapy on primary liver cancer.Methods:The clinical data of 116 patients with primary liver cancer who received stereotactic radiotherapy in Binzhou Central Hospital from February 2018 to April 2020 were retrospectively analyzed. The factors that affect the therapeutic effects of stereotactic radiotherapy on primary liver cancer were analyzed.Results:Stereotactic radiotherapy was effective in 85 patients, with an overall response rate of 73.28%. There were no significant differences in maximum tumor diameter, arteriovenous fistula, portal vein tumor thrombus, distant metastasis, pseudocapsule, liver function Child-Pugh grade, Barcelona clinic liver cancer staging, and the number of stereotactic radiotherapies between different patients ( χ2 = 14.71, 12.76, 19.16, 8.54, 7.30, 7.71, 9.41, 4.08, P < 0.05 or < 0.01). Maximum tumor diameter, portal vein tumor thrombus, pseudocapsule, liver function Child-Pugh grade, Barcelona clinic liver cancer staging, and the number of stereotactic radiotherapies were the independent risk factors that affect the therapeutic effects of stereotactic radiotherapy on primary liver cancer (Wald χ2 = 3.13, 3.75, 4.16, 5.20, 3.90, 3.40, all P < 0.05). Conclusion:Many factors affect the therapeutic effects of stereotactic radiotherapy on primary liver cancer. Early identification of the high-risk factors for primary liver cancer is conducive to minimizing the risk of stereotactic radiotherapy, improving the therapeutic effects of stereotactic radiotherapy, and improving the prognosis. This study is highly innovative and scientific.

Study on the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy combined with 125I seed implantation in patients with primary liver cancer and type Ⅲ portal vein tumor thrombus / 中国医师进修杂志

Objective:To explore the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy (HAIC) combined with 125I seed implantation or gamma knife in patients with primary liver cancer and type Ⅲ portal vein tumor thrombosis (PVTT). Methods:The clinical data of 116 patients with primary liver cancer and type Ⅲ PVTT from January 2016 to June 2018 in the Sixth Medical Center of PLA General Hospital were retrospectively analyzed. Among them, 56 patients were treated with FOLFOX4 regimen HAIC combined with 125I seed implantation in PVTT (observation group), and 56 patients were treated with FOLFOX4 regimen HAIC combined with gamma knife in PVTT (control group). The clinical efficacy, adverse reactions, liver function, tumor serum markers, quality of life and portal venous pressure were compared between 2 groups. The patients were followed up to June 2021, the progression-free survival (PFS) time, overall survival (OS) time and 1-, 3-year survival rate were recorded. Results:The objective response rate and disease control rate in observation group were significantly higher than those in control group: 21.43% (12/56) vs. 7.14% (4/56) and 50.00% (28/56) vs. 30.36% (17/56), and there were statistical differences ( P<0.05). The aspartate transaminase (AST), alanine transaminase (ALT), total bilirubin, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA) and tumor supplied group of factor (TSG) after treatment in observation group were significantly lower than those in control group: (58.24 ± 7.16) U/L vs. (67.81 ± 8.39) U/L, (56.39 ± 5.42) U/L vs. (62.87 ± 6.83) U/L, (21.21 ± 4.32) μmol/L vs. (25.88 ± 4.71) μmol/L, (32.98 ± 6.15) μg/L vs. (45.06 ± 7.24) μg/L, (2.39 ± 0.22) μg/L vs. (3.17 ± 0.26) μg/L and (57.81 ± 5.67) kU/L vs. (66.19 ± 5.45) kU/L, and there were statistical differences ( P<0.01). The quality of life questionnaire core-30 (QLQ-C30) score after treatment in observation group was significantly higher than that in control group: (68.13 ± 6.95) scores vs. (64.49 ± 6.73) scores, the portal venous pressure after treatment in observation group was significantly lower than that in control group: (31.85 ± 3.89) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (35.37 ± 4.23) cmH 2O, and there were statistical differences ( P<0.01). There was no statistical difference in incidence of adverse reactions between 2 groups ( P>0.05). Two cases were lost in observation group and 3 cases in the control group; the PFS time and OS time in observation group were significantly longer than those in control group: (13.36 ± 2.85) months vs. (11.76 ± 2.60) months and (23.36 ± 4.37) months vs. (20.72 ± 3.96) months, and there were statistical differences ( P<0.01); the 1-year survival rate in observation group was significantly higher than that in control group: 70.37% (38/54) vs. 50.94% (27/53), and there was statistical difference ( P<0.05); there was no statistical difference in 3-year survival rate between 2 groups ( P>0.05). Conclusions:The anti-tumor effect and the improvement effect on liver function in patients with primary liver cancer and type Ⅲ PVTT treated with FOLFOX4 regimen HAIC combined with 125I seed implantation are better than combined gamma knife, and it has high safety and longer survival time.

Curative Effect of Lenvatinib Combined with Locoregional Therapy on PD-L1-positive Hepatocellular Carcinoma Patients with Type Ⅰ-Ⅲ Portal Vein Tumor Thrombus According to Cheng's Classification / 肿瘤防治研究

Objective To compare curative effect between lenvatinib combined with locoregional therapy and locoregional therapy on PD-L1-positive hepatocellular carcinoma patients with type Ⅰ-Ⅲ portal vein tumor thrombus according to Cheng's classification. Methods The patients in lenvatinib combined with locoregional therapy group received orally-administered lenvatinib at a dose of 12 mg qd for patients≥60 kg or 8 mg qd for patients < 60 kg. The locoregional therapy group only received locoregional therapy. We retrospectively analyzed the clinical data and prognosis of two groups. Results The CR+PR were 78.1% and 53.6% in the combination group and locoregional therapy group, respectively (P < 0.05). The response rate, disease control rate and overall survival of the combination group were higher than those in the locoregional therapy group (P < 0.05). Conclusion The curative effect and overall survival of lenvatinib combined with locoregional therapy is better than locoregional therapy on PD-L1-positive hepatocellular carcinoma patients with type Ⅰ-Ⅲ portal vein tumor thrombus according to Cheng's classification.

Use of the target territory hepatic artery dye-injection method in anatomical hepatectomy / 中华肝胆外科杂志

The clinical data of patients with hepatocellular carcinoma who underwent anatomical hepatectomy at the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from June 2021 to January 2022 were retrospectively analyzed. Of 4 patients, there were 3 males and 1 female, aged (52.0±3.7) years. These patient underwent anatomical hepatectomy using the " target territory hepatic artery dye-injection" method. There were 2 patients with right hemi liver tumors with portal vein tumor thrombus, and 1 patient with a right anterior section tumor which involved the ventral segment of right anterior branch of portal vein. One patient had a left hemi liver tumor with portal vein tumor thrombus. The surgical operations were right hemihepatectomy combined with thrombectomy of portal vein in 2 patients, right anterior sectionectomy in 1 patient, and left hemihepatectomy combined with thrombectomy of portal vein in 1 patient. There were no postoperative complications including bile fistula or bleeding. The "Target territory hepatic artery dye-injection" method could be used in appropriate by selected patients.

Advances in radiotherapy based comprehensive treatment of primary hepatocellular carcinoma with portal vein tumor thrombus / 中华放射肿瘤学杂志

Primary hepatocellular carcinoma is the fourth most common malignant tumor in China, with the 2nd highest mortality rate. Clinical prognosis of hepatocellular carcinoma complicated with portal vein tumor thrombus is extremely poor. At present, multiple interventions have been adopted to treat primary hepatocellular carcinoma complicated with portal vein tumor thrombus, such as surgery, radiotherapy and targeted therapy, etc. In this article, the treatment of primary hepatocellular carcinoma with portal vein tumor thrombus was summarized, and the effect and prospect of radiotherapy based comprehensive treatment were illustrated.

Recent advances in the combined use of radiation therapy and multimodality therapies for hepatocellular carcinoma with portal vein tumor thrombus / 中华放射医学与防护杂志

Hepatocellular carcinoma (HCC) is prone to invading portal vein system known as portal vein tumor thrombus (PVTT). PVTT is one of the main reasons for poor prognosis of HCC because of its rapid progress and lack of effective treatments, and the optimal treatment strategy remains controversial. With recent advances in techniques, the efficacy and safety of radiation therapy for PVTT has been improved. The optimization of individualized radiotherapy and multimodality treatment is the future direction of research. In this review, we will investigate the current state and future opportunities of radiation therapy and multimodality treatment for HCC with PVTT.

Downstaging treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Hepatocellular carcinoma with portal vein tumor thrombus has a high incidence rate and rapid progression, and there are limited therapies with a poor clinical effect. Although sorafenib is recommended as the sole therapy for such patients in foreign guidelines, studies have shown that some patients may achieve a better outcome via surgical treatment, especially those with tumor thrombus in the first- or second-order branches of the portal vein (type Ⅰ/Ⅱ thrombus according to Cheng’s classification). However in clinical practice, a large proportion of patients cannot undergo radical resection due to extensive lesions, or there may be a high possibility of residual tumor thrombus after surgery due to the presence of tumor thrombus in the main portal vein (type Ⅲ according to Cheng’s classification), and therefore, downstaging resection is needed to improve prognosis. Studies have shown that with the help of palliative therapies including neoadjuvant three-dimensional conformal radiotherapy, (90)Y-loaded microsphere radioembolization, and hepatic arterial infusion chemotherapy, some patients may achieve regression or disappearance of portal vein tumor thrombus, tumor shrinkage, and disappearance of satellite lesions, which helps to achieve tumor downstaging, increase surgical resection rate, and prolong survival time. Multidisciplinary therapy is of vital importance in improving downstaging resection rate in patients with hepatocellular carcinoma and portal vein tumor thrombus.

Current status and perspectives of the treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Portal vein tumor thrombus is one of the most common complications of advanced hepatocellular carcinoma and greatly affects the treatment and prognosis of such patients. With the development and advances in surgical treatment methods, local interventional treatment, radiation therapy, targeted drug therapy, and immunotherapy in recent years, advanced hepatocellular carcinoma with portal vein tumor thrombus is no longer a dilemma in clinical treatment. Both single and combined treatments have achieved good clinical effects. This article reviews the current status, difficulties, and future treatment methods for advanced liver cancer with portal vein tumor thrombus.

Clinical efficacy and prognostic factors analysis of hepatectomy for hepatocellular carcinoma / 中华消化外科杂志

Objective To investigate the clinical efficacy and prognostic factors of hepatectomy for hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 789 HCC patients who were admitted to the Sichuan Cancer Hospital Affiliated to School of Medicine of University of Electronic Science and Technology of China from January 2009 to January 2016 were collected.There were 669 males and 120 females,aged from 42 to 60 years,with a median age of 52 years.Surgical procedures were determined according to the preoperative and intraoperative comprehensive evaluations of patients.Observation indicators:(1) situations of surgical treatment;(2) postoperative pathological examinations of patients;(3) follow-up and survival situations;(4) prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to May 2017.Normality of measurement data was done using the K-S test.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute number or percentage.The survival rate and survival curve were respectively calculated and drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the Log-rank test and COX regression model,respectively.Results (1) Situations of surgical treatment:all the 789 patients underwent successful hepatectomy,liver volume dissected accounting for 32.5％ (range,17.0％-52.0％) of the total liver volume.Of the 789 patients,413 underwent anatomical hepatectomy including 116 of hepatic segmentectomy,136 of right hemihepatectomy,77 of left hemihepatectomy,57 of left lateral lobe hepatectomy,27 of central hepatectomy,376 underwent nonanatomical hepatectomy including 344 of partial hepatectomy,17 of extended right hemihepatectomy,15 of extended left hemihepatectomy.Volume of intraoperative blood loss was 400 mL (range,200-500 mL) in the 789 patients and 173 had intraoperative blood transfusion.Of the 789 patients,240 had postoperative complications (68 with postoperative severe complications),including 65 of liver insufficiency,37 of ascites and pleural effusion,37 of pulmonary complications,19 of infectious complications,17 of cardiovascular complications,17 of abdominal hemorrhage,11 of gastrointestinal complications,9 of neruologic complications,8 of postoperative bile leakage,10 of other complications,11 of death;the same patient can merge multiple complications.The 229 survival patients with complications were cured by symptomatic supportive treatment.Duration of postoperative hospital stay was 9 days (range,7-11 days).(2) Postoperative pathological examinations.Results of postoperative pathological examinations showed 17 patients with bile duct tumor thrombus,92 with naked eye tumor thrombus at portal vein branches and 167 with microvascular invasion.Of the 789 patients,High-,moderate-,low-differentiated carcinoma were detected in 19,678,92 patients,respectively.(3) Follow-up and survival situations:690 of the 789 patients were followed up for 1-96 months,with a median time of 21 months.The l,3,5-year overall survival rates were 82.1％,66.1％,59.2％ in the 789 patients.(4) Prognostic factors analysis:results of univariate analysis showed that level of preoperative alphafetoprotein (AFP),Child grade of preoperative liver function,Barcelona clinic liver cancer staging,tumor diameter,surgical procedure of hepatectomy,volume of intraoperative blood loss,intraoperative blood transfusion,postoperative complications,postoperative severe complications,bile duct tumor thrombus,portal vein tumor thrombus,vascular invasion were related factors affecting prognosis of HCC patients after hepatectomy (x2 =8.603,8.864,39.970,28.978,6.376,26.144,8.955,6.596,9.910,7.288,37.566,19.183,P＜0.05).Results of multivariate analysis showed that tumor diameter,volume of intraoperative blood loss,portal vein tumor thrombus were independent factors affecting prognosis of HCC patients after hepatectomy (hazard ratio =1.085,1.000,2.259,95％ confidence interval:1.053-1.118,1.000-1.001,1.621-3.146,P＜0.05).Conclusion Hepatectomy for HCC has a good safety,with satisfactory clinical efficacy.Tumor diameter,volume of intraoperative blood loss,portal vein tumor thrombus are independent factors affecting prognosis of HCC patients after hepatectomy.

Combination use of TACE and 125I seed implantation for primary hepatic cancer complicated by portal vein tumor thrombus: a meta-analysis / 介入放射学杂志

Objective To compare the clinical effect and safety of transcatheter arterial chemoembolization (TACE) combined with 125I seed implantation with those of pure TACE in treating primary liver cancer (PHC) complicated by portal vein tumor thrombus (PVTT) . Methods Computer and manual retrieval of PubMed, Cochrane Library, CBM, Wan Fang Database, China National Knowledge Internet and other databases was conducted to collect the retrospective cohort studies on the comparison of the clinical effect and safety of the combination use of TACE and 125I seed implantation with those of simple TACE in treating PHC complicated by PVTT, from which the relevant data were extracted. The quality of extracted documents was assessed according to the standard of Cochrane manual. Results A total of eight articles containing 822 patients were included in this study. Meta analysis indicated that both the effective rate and disease control rate for PHC complicated by PVTT in TACE plus 125I seed implantation group were significantly higher than those in pure TACE group, and the differences between the two groups were statistically significant (P<0.05) . The half-year, one-year and 2-year survival rates of TACE plus 125I seed implantation group were better than those of pure TACE group, and the differences between the two groups were statistically significant (P<0.05) . No statistically significant differences in the incidence of severe complications existed between the two groups (P>0.05) . Conclusion In treating PHC complicated by PVTT, the curative effect of TACE plus 125I seed implantation is superior to pure TACE. No obvious difference in the incidence of severe complications exists between the two groups.

Establishment and application of a multidisciplinary team approach for hepatocellular carcinoma with portal vein tumor thrombus / 第二军医大学学报

Portal vein tumor thrombus (PVTT) is one of the most important clinical characteristics of advanced hepatocellular carcinoma (HCC). The incidence of PVTT has been reported to be 44%-66.2% in patients with HCC who were firstly diagnosed, and 80%-90% were patients with advanced HCC. Once PVTT occurs in patients with HCC, the prognosis is very poor, and the natural survival time is only 2.7-4 months. The current treatment strategy for HCC patients with PVTT remains controversial. Sorafenib is recommended as the only treatment option in Europe and America; and a variety of treatment methods, including surgical treatment, transcatheter arterial chemoembolization, radiotherapy, and systemic chemotherapy, were advocated in Asia. At present, there is no consensus on diagnosis and treatment of HCC with PVTT. Our team has established a multidisciplinary team approach for diagnosis and treatment of HCC with PVTT, and has carried out systematic research and application. This article reviews the molecular mechanism of PVTT in patients with HCC, clinical diagnosis and treatment of PVTT, and the establishment and application of a multidisciplinary team approach.

Therapeutic effect of transcatheter arterial chemoembolization combined with iodine-125 seed strand implantation for treating hepatocellular carcinoma with portal vein tumor thrombus / 中华肝胆外科杂志

Objective To study the efficacy of combined transcatheter arterial chemoembolization(TACE)with iodine-125 seed implantation in treating hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT).Methods From January 2015 to January 2019,eighty patients with HCC and PVTT who were treated at Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.A total of 71 patients were male and 9 were female.aged(53.1±9.9)years.The patients included 48 patients(group A)who were treated with TACE alone and 32 patients(group B)with TACE combined with iodine-125 seed implantation.The survival time and disease control rate(DCR)of the intrahepatic lesions and PVTY in the two groups were compared.Results There were 32 patients who were successfully implan-ted with portal vein iodine-125 seed and stents.The DCR of PVTT in group B was significantly better than in group A(90.6％ vs.81.3％,P＜0.05).The DCR of the intrahepatic lesions in the two groups was 77.1％(group A)and 90.6％(group B).There was no significant difference between the two groups(P＞0.05).The survival times of group A and group B were(8.0±0.6)and(16.0±2.1)months,respectively.The median survival times were(7.6±1.0)and(14.8±1.5)months respectively.Group B had significantly better survival time than Group A,(both P＜0.05).Univariate and multivariate analysis showed that tumor size was an independent risk factor of prognosis(Regression coemcient:0.960,HR:0.383,95％CI:0.158-0.926,P＜0.05).125I treatment was a protective factor of prognosis(Regression coefficient:-1.525,HR:0.218,95％CI:0.100-0.473,P＜0.05).Conclusion For patients with HCC and PVTT.compared with TACE alone,TACE combined with iodine-125 seed implantation could safe-ly and effectively control portal vein tumor thrombus,and prolonged patient survival.

Risk factor analysis of recurrent hepatocellular carcinoma with portal vein tumor thrombus / 中国实用外科杂志

OBJECTIVE: To investigate the effect of clinicopathological factors on the recurrent hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)after radical resection.METHODS: The data of patients with HCC who underwent radical resection between January 2000 and December 2014 in Affiliated Hospital of Qingdao University were analyzed retrospectively.Clinical and pathological data from first resection to the recurrence of HCC with PVTT were extracted in the form of data tables.All patients were divided into PVTT group and non PVTT group according to the occurence of PVTT at time of HCC recurrence,and the risk factors of PVTT formation were analyzed.Risk factors influencing the formation time,from radical resection to HCC recurrence,were analyzed in recurrent HCC patients with PVTT.RESULTS: Univariate analysis results showed that patients having HCC with multiple tumors,no tumor capsule,and Child-pugh B grade had a high proportion of PVTT when HCC recurred.The results of logistic regression analysis showed that multiple tumors,no tumor capsule,and Childpugh B grade were independent risk factors for PVTT formation after radical resection of HCCA predictive model was established on the basis of the three risk factors(1 point for each factor).ROC curve showed the total model score has certain predictive value.The area under the curve was 0.662(P=0.003,95% CI:0.557-0.766),cut-off value was 0.5 points,Youden index was 0.302(sensitivity=60.0%,specificity=70.2%).The higher the model score,the shorter the tumor-free survival time(P=0.007),and the higher the incidence of PVTT recurrence(P=0.001).The results of Kaplan-Meier(log-rank test)and multivariate analysis of Cox regression model showed that lower differentiation of HCC was an independent risk factor influencing the time from radical resection to HCC recurrence with PVTT(P=0.000). CONCLUSION: Patients with multiple tumor foci,no tumor capsule and Child grade B grade liver cancer are more likely to recur with PVTT after RO operation.And among them,the low differentiation of liver cancer grows faster.A closer follow-up or preventive treatment of patients with high-risk factors may improve prognosis.

Therapeutic effect of transcatheter arterial chemoembolization combined with iodine-125 seed strand implantation for treating hepatocellular carcinoma with portal vein tumor thrombus / 中华肝胆外科杂志

Objective@#To study the efficacy of combined transcatheter arterial chemoembolization (TACE) with iodine-125 seed implantation in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).@*Methods@#From January 2015 to January 2019, eighty patients with HCC and PVTT who were treated at Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. A total of 71 patients were male and 9 were female, aged (53.1±9.9) years. The patients included 48 patients (group A) who were treated with TACE alone and 32 patients (group B) with TACE combined with iodine-125 seed implantation. The survival time and disease control rate (DCR) of the intrahepatic lesions and PVTT in the two groups were compared.@*Results@#There were 32 patients who were successfully implanted with portal vein iodine-125 seed and stents. The DCR of PVTT in group B was significantly better than in group A (90.6% vs. 81.3%, P<0.05). The DCR of the intrahepatic lesions in the two groups was 77.1% (group A) and 90.6% (group B). There was no significant difference between the two groups (P>0.05). The survival times of group A and group B were (8.0±0.6) and (16.0±2.1) months, respectively. The median survival times were (7.6±1.0) and (14.8±1.5) months respectively. Group B had significantly better survival time than Group A, (both P<0.05). Univariate and multivariate analysis showed that tumor size was an independent risk factor of prognosis (Regression coefficient: 0.960, HR: 0.383, 95% CI: 0.158-0.926, P<0.05). 125I treatment was a protective factor of prognosis (Regression coefficient: -1.525, HR: 0.218, 95% CI: 0.100-0.473, P<0.05).@*Conclusion@#For patients with HCC and PVTT, compared with TACE alone, TACE combined with iodine-125 seed implantation could safely and effectively control portal vein tumor thrombus, and prolonged patient survival.

A clinical study on transcatheter arterial chemoembolization plus portal vein chemoembolization after partial hepatectomy for patients with hepatocellular carcinoma with portal vein tumor thrombosis / 中华肝胆外科杂志

Objective To study the short and long term outcomes in patients after partial hepatectomy carried out for primary hepatocellular carcinoma (PHC) with portal vein tumor thrombosis (PVTF) who were treated with transcatheter arterial chemoembolization (TACE) plus portal vein chemoembolization (PVCE).Methods 57 patients who underwent partial hepatectomy for PHC with PVTT were treated with TACE + PVCE.These patients formed the study group.Another 55 such patients who received TACE only were matched by age and gender to form the control group.Blood samples before and after treatment for these 2 groups were collected to study the serum tumor markers.Any chemotherapy-related toxicity and complications were recorded.The hepatocellular carcinoma recurrence rate and recurrence time were recorded on follow up.Survival analysis was conducted.Results There was no significant difference between the two groups in TACE treatment times (P ＞ 0.05).In the study group,the levels of AFP,IGF-Ⅱ,and IGFBP-2 were significantly lower than those in the control group at 1 month after chemotherapy [respectively,(4.3 ± 0.5) μg/L vs.(4.8±0.6) μg/L,(3.3±0.4) μg/L vs.(4.0±0.5) μg/L,(5.3±0.6) μg/L vs.(5.8 ± 0.6) μg/L;all P ＜ 0.05].The range of follow-up of the patients in this study were 9 to 45 months after operation.The 1 year recurrence rate after operation in the study group was significantly lower than those in the control group (28.1％ vs.47.3％) (P＜0.05).The PFS,OS,2 year and 3 year survival rates were all significantly higher than those in the control group [respectively,(13.4 ± 4.6) m vs.(11.0±3.5) m,(22.6±10.9) m vs.(17.2 ±10.1) m,43.9％ vs.25.5％,33.3％ vs.16.4％].The differences in the PFS and OS between the two groups were significantly different (P ＜ 0.05).There was no significant difference in the rates in toxicity between the two groups (P ＞ 0.05).In the study group,2 patients (3.5％) developed bleeding from esophageal and gastric fundus vein rupture,while there were no such cases in the control group.Conclusion Compared with TACE alone,the combination of PVCE and TACE after partial hepatectomy for patients with PHC with PVTT effectively reduced tumor burden,prevented liver recurrence and improved long-term survival rates,with no significant increase in toxicity and complication rates.

New progress in the diagnosis and treatment of hepatocellular carcinoma combined with portal vein tumor thrombus / 中国综合临床

The early diagnosis of primary hepatocellular carcinoma combined with portal vein tumor thrombus is very difficult,and when the patients are diagnosed,they are usually at an advanced stage,and the optimal treatment time has missed. In recent years, more and more scholars believe that the diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus need multi?disciplinary diagnosis and treatment,it also has a certain effect in the clinic, it is expected to make the early diagnosis and the early treatment for patients with hepatocellular carcinoma combined with portal vein tumor thrombus in the future,and form a standardized treatment process.

Bottleneck and strategies in the treatment of hepatocellular carcinoma with portal vein tumor thrombus / 中华消化外科杂志

Hepatocellular carcinoma (HCC) is prone to invading portal vein system known as portal vein tumor thrombus (PVTT).PVTT is one of the main reasons for poor prognosis of HCC because of its rapid progress and lack of effective treatments.In recent years,with the development of new therapeutic concepts and methods,the curative effect of PvTr has been improved.But there are still many difficulties of treatment of PVTT:how to definite the indications of various treatment of PVTT,how to innovate treatment methods,how to carry out the multidisciplinary treatment and how to conduct high-quality evidence-based clinical research.The strategies need to be built for these bottlenecks.Chinese Expert Consensus on Multidisciplinary Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus (2016 edition) also provided a powerful reference experience for clinical treatment and research.Researchers should develop new treatment methods,popularize the idea of multidisciplinary treatment and conduct high-quality evidence-based clinical research in the future to improve the curative effect of PVTT patients.