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Abstract：
BACKGROUND: Patients with hepatocellular carcinoma complicated with main portal vein tumor thrombosis (mPVTT) and cirrhotic portal hypertension (CPH) have an extremely poor prognosis, and there is a lack of a clinically effective treatment paradigm.
OBJECTIVE: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with radioactive seed strand for the treatment of mPVTT patients with CPH.
METHODS: The clinical data of 83 consecutive patients who underwent TIPS combined with 125I seed strand placement for mPVTT and CPH from January 2015 to December 2018 were retrospectively reviewed. Procedure-related data (success rate, relief of portal vein pressure and CPH symptoms, and adverse events), PVTT response, and patient survival were assessed through a 2-year follow-up.
RESULTS: The success rate was 100.0% without perioperative death or procedure-related severe adverse events. The mean portal vein pressure was significantly decreased after the procedure (22.25 ± 7.33 mmHg vs 35.12 ± 7.94 mmHg, t = 20.61, P < 0.001). The symptoms of CPH were all effectively relieved within 1 mo. The objective response rate of PVTT was 67.5%. During a mean follow-up of 14.5 ± 9.4 mo (range 1-37 mo), the cumulative survival rates at 6, 12 and 24 mo were 83.1%, 49.7%, and 21.8%, respectively. The median survival time was 12.0 ± 1.3 mo (95% confidence interval: 9.5-14.5). In multivariate Cox regression analysis, body mass index, Child-Pugh grade, cTNM stage, and PVTT response were independent prognostic factors (P < 0.05).
CONCLUSIONS: TIPS combined with radioactive seed strand might be effective and safe in treating mPVTT patients with CPH.
OBJECTIVE: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with radioactive seed strand for the treatment of mPVTT patients with CPH.
METHODS: The clinical data of 83 consecutive patients who underwent TIPS combined with 125I seed strand placement for mPVTT and CPH from January 2015 to December 2018 were retrospectively reviewed. Procedure-related data (success rate, relief of portal vein pressure and CPH symptoms, and adverse events), PVTT response, and patient survival were assessed through a 2-year follow-up.
RESULTS: The success rate was 100.0% without perioperative death or procedure-related severe adverse events. The mean portal vein pressure was significantly decreased after the procedure (22.25 ± 7.33 mmHg vs 35.12 ± 7.94 mmHg, t = 20.61, P < 0.001). The symptoms of CPH were all effectively relieved within 1 mo. The objective response rate of PVTT was 67.5%. During a mean follow-up of 14.5 ± 9.4 mo (range 1-37 mo), the cumulative survival rates at 6, 12 and 24 mo were 83.1%, 49.7%, and 21.8%, respectively. The median survival time was 12.0 ± 1.3 mo (95% confidence interval: 9.5-14.5). In multivariate Cox regression analysis, body mass index, Child-Pugh grade, cTNM stage, and PVTT response were independent prognostic factors (P < 0.05).
CONCLUSIONS: TIPS combined with radioactive seed strand might be effective and safe in treating mPVTT patients with CPH.
摘要：
背景：肝细胞癌合并主门静脉癌栓（mPVTT）和肝硬化门静脉高压（CPH）的患者预后极差，缺乏临床有效的治疗模式。
目的：评价经颈静脉肝内门体分流术(TIPS)联合放射性种子链治疗mPVTT伴CPH患者的疗效和安全性。
方法：回顾性分析2015年1月至2018年12月83例连续行TIPS联合125I粒子链置入治疗mPVTT和CPH患者的临床资料。程序相关数据(成功率，缓解门静脉压力和CPH症状，和不良事件)，PVTT响应,通过2年随访评估患者生存率.
结果：成功率为100.0%，无围手术期死亡或手术相关严重不良事件。术后平均门静脉压明显下降(22.25±7.33mmHgvs35.12±7.94mmHg,t=20.61,P<0.001)。CPH症状均在1个月内有效缓解。PVTT的客观有效率为67.5%。在平均随访14.5±9.4个月(范围1-37个月)期间，6、12和24个月的累积生存率为83.1%，49.7%,和21.8%，分别。中位生存时间为12.0±1.3mo（95％置信区间：9.5-14.5）。在多元Cox回归分析中，身体质量指数,Child-Pugh年级,cTNM阶段，PVTT反应是影响预后的独立因素(P<0.05)。
结论：TIPS联合放射性种子链治疗mPVTT伴CPH患者可能是安全有效的。
目的：评价经颈静脉肝内门体分流术(TIPS)联合放射性种子链治疗mPVTT伴CPH患者的疗效和安全性。
方法：回顾性分析2015年1月至2018年12月83例连续行TIPS联合125I粒子链置入治疗mPVTT和CPH患者的临床资料。程序相关数据(成功率，缓解门静脉压力和CPH症状，和不良事件)，PVTT响应,通过2年随访评估患者生存率.
结果：成功率为100.0%，无围手术期死亡或手术相关严重不良事件。术后平均门静脉压明显下降(22.25±7.33mmHgvs35.12±7.94mmHg,t=20.61,P<0.001)。CPH症状均在1个月内有效缓解。PVTT的客观有效率为67.5%。在平均随访14.5±9.4个月(范围1-37个月)期间，6、12和24个月的累积生存率为83.1%，49.7%,和21.8%，分别。中位生存时间为12.0±1.3mo（95％置信区间：9.5-14.5）。在多元Cox回归分析中，身体质量指数,Child-Pugh年级,cTNM阶段，PVTT反应是影响预后的独立因素(P<0.05)。
结论：TIPS联合放射性种子链治疗mPVTT伴CPH患者可能是安全有效的。
