A combination of portal vein stent insertion and endovascular iodine-125 seed-strip implantation, followed by transcatheter arterial chemoembolization with sorafenib for treatment of hepatocellular carcinoma-associated portal vein tumor thrombus

Introduction
This study aimed to assess efficacy of portal vein stent (PVS) insertion and endovascular iodine-125 (125I) seed-strip implantation, followed by transcatheter arterial chemoembolization (TACE) with sorafenib (PVS-125I TACE-S) in patients with hepatocellular carcinoma (HCC)-associated type II or type III portal vein tumor thrombus (PVTT).

Material and methods
A retrospective study was performed on 53 consecutive patients with HCC and type II or type III PVTT, from May 2014 to July 2018. Patients were divided into 2 groups, including group A with 28 patients treated with PVS-125I TACE-S, and group B with 25 patients treated with TACE-S. Primary end-point was overall survival (OS), while secondary endpoints were hepatic function and disease control rate (DCR). Albumin-bilirubin (ALBI) score approach was used for evaluating liver function. Cox regression analysis was applied to identify factors associated with treatment outcomes.

Results
No pre-operative differences were found in ALBI scores between group A and group B (–2.57 ±0.42 vs. –2.61 ±0.38, p = 0.724), or in these scores at 1 month post-operatively (–2.62 ±0.46 vs. –2.20 ±0.59, p = 0.666). However, these scores were significantly different at 3 (–2.17 ±0.59 vs. –1.69 ±0.48, p = 0.007) and 6 (–2.28 ±1.23 vs. –1.47 ±0.31, p = 0.044) months post-operatively. In addition, group A exhibited higher DCR (71.4% vs. 44.0%, p = 0.043) after 6 months of treatment and extended OS duration (11.4 vs. 7.7 months, p = 0.007). A stratified analysis revealed that OS in patients with type II PVTT did not differ significantly (10.4 vs. 10.7 months, p = 0.689), but OS with type III varied significantly (11.5 vs. 7.5 months, p = 0.002). Multivariate analysis revealed that tumor size > 10 cm (p = 0.002) and multiple tumors (p = 0.022) were independent predictors for poor prognosis, whereas PVS-125I TACE-S was predictor for favorable patient’s prognosis (p = 0.040).

Conclusions
PVS-125I TACE-S represents a potentially viable strategy for improving hepatic functionality, DCR, and OS in HCC with type III PVTT compared with TACE-S alone.