Clinical effect of microwave ablation combined with transcatheter arterial chemoembolization in treatment of primary hepatocellular carcinoma with portal vein tumor thrombus and related influencing factors

Objective To investigate the clinical effect of microwave ablation(MWA) combined with transcatheter arterial chemoembolization(TACE) in the treatment of primary hepatocellular carcinoma(PHC) with portal vein tumor thrombus(PVTT) and related influencing factors. Methods A total of 92 patients with PHC and PVTT who were admitted to Chengdu Seventh People's Hospital from January 2016 to March 2018 were enrolled,among whom 47 patients treated with MWA combined with TACE were enrolled as combined treatment group and 45 treated with TACE alone were enrolled as control group. The two groups were compared in terms of short-term outcome,survival,incidence rates of adverse reactions and complications,and rates of complete response(CR),partial response(PR),stable disease(SD),and progressive disease(PD),as well as response rate(RR) at 3 months after surgery(RR = CR + PR). The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for survival analysis,the log-rank test was used for univariate analysis of possible factors,and a Cox stepwise regression analysis was used for multivariate analysis. Results At 3 months after the treatment ended,there was a significant difference in RR between the combined treatment group and the control group(42. 2% vs 11. 9%,χ2= 8. 679,P < 0. 05). The adverse reactions such as pyrexia,nausea and vomiting,and liver area pain were observed in both groups. The combined treatment group had 1-,2-,and 3-year cumulative survival rates of 44. 7%,23. 4%,and 6. 4%,respectively,and the control group had 1-,2-,and 3-year cumulative survival rates of 22. 5%,8. 9%,and 0,respectively. The combined treatment group had a significantly longer median survival time than thecontrol group(10. 9 months vs 5. 1 months,χ2= 5. 749,P < 0. 05). Preoperative alpha-fetoprotein,number of tumors,tumor size,type of PVTT,Barcelona Clinic Liver Cancer(BCLC) stage,and Child-Pugh class were associated with the survival of the patients with PHC and PVTT(χ2= 9. 356,7. 641,11. 352,9. 764,8. 236,and 17. 392,all P < 0. 05). The multivariate analysis showed that tumor size(hazard ratio[HR]= 1. 997,95% confidence interval [CI]: 1. 608-3. 145,P < 0. 05),type of PVTT(HR = 1. 584,95% CI: 1. 306-2. 757,P< 0. 05),BCLC stage(HR = 1. 690,95% CI: 1. 035-2. 683,P < 0. 05) were independent influencing factors for survival. Conclusion MWA combined with TACE has good safety and efficacy in the treatment of patients with PHC and PVTT. Tumor size,type of PVTT,BCLC stage are the main influencing factors for prognosis.