Treatment of Hepatocellular Carcinoma-associated Portal Vein Tumor Thrombus Using Combination of Portal Vein Stent Insertion and Endovascular Lodine-125 Seed-strip Implantation Followed by Transcatheter Arterial Chemoembolization- Sorafenib

BackgroundTo evaluate the efficacy of portal vein stent (PVS) insertion and endovascular iodine-125 (125I) seed-strip implantation followed by transcatheter arterial chemoembolization (TACE)-sorafenib (PVS-125I-TACE-S) in patients with hepatocellular carcinoma (HCC)-associated portal vein tumor thrombus (PVTT).MethodsThis retrospective analysis was performed on 53 consecutive HCC patients with PVTT between May 2014 and July 2018. Twenty-eight patients were treated via PVS-125I-TACE-S, and 25 patients were treated by TACE-S. Hepatic function, disease control, and overall survival (OS) in both groups were analyzed. The Albumin-Bilirubin (ALBI) score approach was used as a means of evaluating liver function, and a Cox regression analysis was utilized to determine which factors were linked to treatment outcomes.ResultsNo preoperative differences in ALBI scores between groups (P=0.724), nor did these scores at 1-month postoperative (P=0.666). However, these scores were significantly different at 3 (P=0.007) and 6 (P=0.044) months postoperatively. PVS-125I-TACE-S exhibiting higher rates of disease control (71.4% vs. 44.0%, P=0.043) after 6 months of treatment and extended OS duration (342.0 vs 231.0 days, P=0.007). A stratified analysis revealed OS in patients with type II PVTT did not differ significantly (313.0 vs. 321.0 days, P=0.689), but OS with type III did (344.0 vs. 226.0 days, P=0.002). A multivariate analysis revealed that tumor size > 10 cm was independently predictive of poor prognosis (P=0.002), whereas PVS-125I-TACE-S was a predictor of a favorable patient prognosis (P=0.040).ConclusionPVS-125I-TACE-S represents a potentially viable strategy for improving hepatic functionality, disease control, and OS in HCC with type III PVTT.