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

ABSTRACT

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.