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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 3
Mar.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(3): 611-615

Clinical effect of transcatheter arterial chemoembolization in treatment of patients with hepatocellular carcinoma and portal vein tumor thrombus and an analysis of prognostic evaluation models

DOI: 10.3969/j.issn.1001-5256.2021.03.021

  • Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an 710032, China

  • Received Date: 2020-11-10
  • Accepted Date: 2020-12-08
  • Published Date: 2021-03-20
    Abstract
  •   Objective  To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) in the treatment of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus and the value of existing prognostic evaluation models for HCC.  Methods  Screening was performed for HCC patients who underwent TACE in 24 tertiary hospitals in China from January 2010 to May 2016, and finally 266 HCC patients with portal vein tumor thrombus were included for retrospective analysis. The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for comparison; a Cox regression analysis was used to perform univariate and multivariate analyses and establish a Cox regression model; area under the ROC curve (AUC) and C-index were calculated for HAP score, mHAP score, mHAP2 score, mHAP3 score, and 6&12 criteria to compare their prediction performance.  Results  The median survival time was 9.867 months for all patients, and according to Child-Pugh class, the patients with Child-Pugh class A HCC had a significantly longer median survival time than those with Child-Pugh class B HCC (10.067 months vs 5.967 months, χ2=5.181, P=0.023). The patients with alpha-fetoprotein (AFP) ≤800 ng/ml had a significantly longer median survival time than those with AFP > 800 ng/ml (13.10 months vs 8.13 months, χ2=8.643, P=0.003). The univariate analysis showed that number of tumors, tumor diameter, total bilirubin, serum albumin, alanine aminotransferase (AST), and alanine aminotransferase (ALT) were associated with the survival of patients (all P < 0.05), and the multivariate analysis showed that number of tumors (hazard ratio [HR]=1.186, 95% confidence interval [CI]: 1.058-1.329, P < 0.05) and tumor diameter (HR=1.047, 95% CI: 1.001-1.095, P < 0.05) were independent influencing factors for the survival of patients. The 1-, 2-, and 3-year AUCs of 6&12 criteria were 0.651, 0.655, and 0.641, respectively, which were higher than those of the other models; 6&12 criteria and the new model had a C-index of 0.577 and 0.579, respectively, which were higher than C-index of the other models.  Conclusion  TACE is safe and effective in HCC patients with portal vein tumor thrombus who have a low AFP level and good liver function. Tumor diameter and number of tumors provide a reliable basis for screening out the patients suitable for TACE. Among the existing prognostic evaluation models for primary liver cancer, 6&12 criteria have a better predictive capability than the other models.

     

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