Objective: To explore the factors affecting the prognosis of patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT), and to analyze the clinical value of transcatheter arterial chemoembolization (TACE) combined with iodine-125 seed implantation in such patients. Methods: A retrospective analysis of 53 patients with HCC combined with PVTT was performed. In the study group, 32 cases were treated with TACE combined with iodine-125 seed implantation, and 21 cases in the control group were treated with TACE combined with sorafenib. Survival analysis was carried out on eight factors such as gender, age, Child-Pugh classification, alpha fetoprotein level, portal vein tumor thrombosis (PVTT) type, forms of liver tumor, extra-hepatic metastasis and treatment modalities. The efficacy of TACE combined with iodine-125 seed implantation and TACE combined with sorafenib was further compared. The χ (2) test was used to evaluate the efficacy of the two groups. A single factor survival analysis was calculated by Kaplan-Meier estimator and multifactor survival analysis by Cox proportional hazards model. Results: All 53 patients were successfully treated. The median tumor progression time (mTTP) and median overall survival (mOS) were 8 months and 11 months, respectively. The disease control rate (DCR) of the study group for PVTT was 93.8%, which was significantly higher than that of the control group (61.9%, χ (2) = 6.448, P = 0.011). The difference was statistically significant; the objective remission rate of the study group for PVTT was 75.0%. Significantly higher than 9.5% in the control group, P < 0.05, the difference was statistically significant; the DCR of the primary tumor in the study group was 50.0%, which was lower than the 70.0% of the PVTT in the control group, P = 0.231, the difference was not statistically significant. The progression of primary HCC lesions in patients with multivariate survival analysis: Child-Pugh grade A patients were compared to grade B [Hazard ratio (HR) = 0.236, P = 0.003]; no extra-hepatic metastasis (HR = 0.258, P = 0.002); and TACE combined with iodine-125 seed implantation group compared with TACE combined sorafenib group (HR = 0.372, P = 0.002), the differences were statistically significant. Multivariate survival analysis of patients with overall survival: AFP < 400 ng/mL vs. AFP≥400 ng/mL (HR = 0.389, P = 0.030); Child-Pugh grade A vs. B (HR = 0.263, P = 0.006); and no extra-hepatic metastasis (HR = 0.306, P = 0.006), the differences were statistically significant. Conclusion: TACE combined with iodine-125 seed implantation for the treatment of HCC with PVTT can effectively control the progression of PVTT and intrahepatic lesions and improve the prognosis of patients.
目的： 探讨影响肝细胞癌（HCC）合并门静脉癌栓（PVTT）患者预后的因素，并分析肝动脉化疗栓塞（TACE）联合(125)I粒子植入在此类患者中的临床价值。 方法： 回顾性分析HCC合并PVTT患者53例，其中研究组32例行TACE联合(125)I粒子植入治疗，对照组21例行TACE联合索拉非尼治疗。对性别、年龄、Child-Pugh分级、甲胎蛋白水平、PVTT分型、肝脏肿瘤类型、肝外转移及治疗模式这8个因素行生存分析，进一步比较TACE联合(125)I粒子植入及TACE联合索拉非尼的疗效。两组间疗效评价采用χ(2)检验；单因素生存分析采用Kaplan-Meier法计算；多因素生存分析采用Cox比例风险模型。 结果： 53例患者均顺利完成治疗，中位肿瘤进展时间（mTTP）和中位总生存期（mOS）分别为8个月和11个月。研究组对于PVTT的疾病控制率（DCR）为93.8%，显著高于对照组的61.9%，χ(2) = 6.448，P = 0.011，差异有统计学意义；研究组对于PVTT的客观缓解率为75.0%，显著高于对照组的9.5%，P < 0.05，差异有统计学意义；研究组对于HCC原发肿瘤病灶的DCR为50.0%，低于对照组PVTT的66.7%，P = 0.231，差异无统计学意义。多因素生存分析患者HCC原发肿瘤病灶进展情况：Child-Pugh为A级的患者对比B级[风险比（HR）= 0.236, P = 0.003］；无肝外转移对比有肝外转移（HR = 0.258，P = 0.002）；以及采用TACE联合(125)I粒子植入组对比TACE联合索拉非尼组（HR = 0.372，P = 0.002），差异均有统计学意义。多因素生存分析患者总生存期：AFP < 400 ng/ml对比AFP≥400 ng/ml，HR = 0.389，P = 0.030；Child-Pugh为A级对比B级，HR = 0.263，P = 0.006；无肝外转移对比有肝外转移，HR = 0.306，P = 0.006；差异均有统计学意义。 结论： TACE联合(125)I粒子植入治疗HCC伴PVTT，可有效控制PVTT和肝内病灶进展，改善患者预后。.
Keywords: (125)I seeds; Carcinoma, hepatocellular; Port vein tumor thrombosis; Prognosis; Sorafenib; Treatment outcome.