Clinical effect of polyvinyl alcohol particles combined with chemoembolization in treatment of hepatocellular carcinoma complicated by hepatic arteriovenous shunt and related and prognostic factors
10.3760/cma.j.issn.1007-3418.2016.11.008
- VernacularTitle:聚乙烯醇微粒联合化学治疗栓塞对肝细胞癌合并肝动-静脉分流的临床疗效与生存预后分析
- Author:
Qiusong LIU
1
;
Quelin MEI
;
Yanhao LI
;
Xiaofeng HE
;
Qingle ZENG
;
Huajin PANG
;
Lijun XIAO
Author Information
1. 361004,厦门大学附属中山医院肿瘤与血管介入科
- Keywords:
Carcinoma,hepatocellular;
Treatment outcome;
Prognosis
- From:
Chinese Journal of Hepatology
2016;24(11):834-839
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical effect of polyvinyl alcohol (PVA) particles combined with chemoembolization using chemotherapeutic agents or chemotherapeutic agents lipiodol emulsion (CALE)in the treatment of hepatocellular carcinoma (HCC) complicated by hepatic arteriovenous shunt (HAVS) and related prognostic factors.Methods A retrospective analysis was performed for the clinical data of 133 patients with HCC complicated by HAVS.HAVS was classified into slow-flow HAVS,intermediate-flow HAVS,and high-flow HAVS,which were treated with 300-500 μm,500-710 μm,and 710-1000 μm PVA particles,respectively.The patients with slow-flow and intermediate-flow HAVS underwent embolization with PVA combined with chemotherapeutic agents followed by CALE,while those with high-flow HAVS underwent the treatment with PVA combined with chemotherapeutic agents alone.The survival time,progression-free survival time,and postoperative complications were followed up and analyzed.The Kaplan-Meier method was used to calculate cumulative survival rate and the Cox proportional hazards model was used to determine prognostic factors.Results The median overall survival (OS) of 133 patients was 9.1 months,and the 6-,12-,and 24-month survival rates were 73.7％,36.2％,and 10.2％,respectively.The median OS of slow-flow group (36 patients),intermediate-flow group (58 patients),and high-flow group (39 patients) were 7.3,9.1,and 10.8 months,respectively.And the 6-and 12-month survival rates were 69.2％/19.0％,72.4％/39.2％,and 77.8％/42.7％,respectively.There was no significant difference in survival time between the patients with different types of HAVS (x 2 =2.865,P =0.239).The incidence rates of postoperative gastroesophageal variceal bleeding and acute liver failure were 1.1％ and 0.4％,respectively.The results of Cox regression analysis showed that preoperative alpha-fetoprotein level ≥ 400 ng/ml (HR =2.105,P =0.006) was an independent risk factor,while multiple embolizations (H7 =0.482,P =0.011),tumor remission (HR =0.431,P =0.041),and multimodality therapy (HR =0.416,P =0.004) were independent protective factors.Conclusion PVA particles combined with chemotherapeutic agents or CALE is safe and effective in the treatment of HCC complicated by HAVS.Patients with multiple embolizations,tumor remission,and multimodality therapy tend to have good prognosis,while those with a high level of alpha-fetoprotein before embolization often have poor prognosis.
