Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2019; 11(4): 310-321
Published online Apr 15, 2019. doi: 10.4251/wjgo.v11.i4.310
Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus
Yue Zhang, Yi-Fan Wu, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Tao Wang, Fu-Quan Liu
Yue Zhang, Fu-Quan Liu, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
Yi-Fan Wu, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
Tao Wang, Department of Interventional Therapy, The affiliated Yantai Yuhuangding Hospital of Qingdao University, No.20 Yuhuangding East Road, Yantai 264000, Shandong Province, China
Author contributions: Liu FQ designed the research; Wu YF, Yue ZD, Zhao HW, Wang L, Fan ZH and He FL performed the research; Zhang Y analyzed the data and wrote the paper; Wu YF and Liu FQ critically revised the manuscript for important intellectual content.
Supported by the Beijing Municipal Science and Technology Commission project, the Capital of the Public Health Cultivation - Transcatheter Implantation combined with TACE/TAE in the treatment of portal vein tumor thrombus in clinical research, No. Z171100000417031.
Institutional review board statement: All patients involved in this study gave their informed consent. Institutional review board approval of our hospital was obtained for this study.
Informed consent statement: Written informed consent was obtained from all subjects (patients) in this study.
Conflict-of-interest statement: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
STROBE statement: The STROBE Statement has been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, BCPS, MD, Professor, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, No. 10 Tie Yi Road, Yangfangdian, Haidian District, Beijing 100010, China. lfuquan@aliyun.com
Telephone: +86-13701179758
Received: January 13, 2019
Peer-review started: January 14, 2019
First decision: January 26, 2019
Revised: February 11, 2019
Accepted: March 12, 2019
Article in press: March 12, 2019
Published online: April 15, 2019
Abstract
BACKGROUND

Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma (HCC). Therefore, attention should be paid to the treatment of MPVTT and its complications.

AIM

To evaluate the efficacy of transarterial chemoembolization/transarterial embolization (TACE/TAE)+125I seeds implantation with transjugular intrahepatic portosystemic shunt (TIPS) in treating MPVTT and its complications.

METHODS

From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and 125I implantation (TIPS-125I group) or TACE/TAE + TIPS only (TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-125I.

RESULTS

During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively (P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 31.1%, 62.2%, and 82.2% (P < 0.05). The rates of stent restenosis were 12.5%, 27.5%, and 42.5%, respectively, in the TIPS-125I group, and 42.2%, 68.9%, and 84.4%, respectively, in the TIPS only group (P < 0.05). TIPS-125I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.

CONCLUSION

TACE/TAE+125I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.

Keywords: Iodine-125, Transjugular intrahepatic portosystemic shunt, Main portal vein tumor thrombus, Metastasis, Portal hypertension

Core tip: 125I implantation combined with transjugular intrahepatic portosystemic shunt (TIPS) was used to treat patients with liver cancer and main portal vein tumor thrombus. This was a controlled study to assess the efficacy of 125I implantation combined with TIPS. Transarterial chemoembolization/transarterial embolization plus 125I combined with TIPS was effective in treating portal vein trunk tumor thrombus and its complications, improving quality of life of patients, and reducing mortality.