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

Purpose: This study aimed to assess efficacy of portal vein stent (PVS) insertion and endovascular iodine-125 (I-125) seed-strip implantation, followed by transcatheter arterial chemoembolization (TACE) with sorafenib ((PVSI)-I-125 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 (PVSI)-I-125 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 (PVSI)-I-125 TACE-S was predictor for favorable patient's prognosis (p = 0.040). Conclusions: (PVSI)-I-125 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.