Effects Of TACE Combined With Sorafenib And Immunotherapy On Survival Of Patients With Hepatocellular Carcinoma Based On ALBI Grades,Child-Pugh Grades And Tumor Load Stratification And Establishment Of Prognosis Prediction Model

Background and purpose: Hepatocellular Carcinoma(HCC)is the fifth most common malignant tumor in China and the second leading cause of cancer-related death.Transcatheter arterial chemoembolization(TACE)and immunotherapy are widely used in the treatment of liver cancer.How to choose a better treatment strategy from many treatment options,this study analyzed the survival of patients with liver cancer based on Albumin-Bilirubin(ALBI)grades and tumor load stratification,and established a nomogram model.Methods:1.The clinical datas of 354 patients with unresectable primary liver cancer and recurrent liver cancer after radical resection who received TACE combined with or without sorafenib in our hospital from 2017 to 2020 were investigated retrospectively.After 1:2 propensity score matching(PSM),eighty-one cases in TACE + SORA group and 162 cases in TACE group were included.2.In addition,the newly diagnosed 46 patients with advanced liver cancer in our hospital from 2019 to 2020 were retrospectively investigated.All patients were given programmed cell death protein 1(PD-1)inhibitors combined with antiangiogenic therapy and/or TACE.Results:1.Patients who received TACE combined with Sorafenib had a longer life span than those treated with TACE alone(median progression free survival(PFS): 9.0 months vs 6.0 months,median overall survival(OS): 24.0months vs 17.0 months;P = 0.000).2.Compared with TACE alone,patients with better liver function(especially ALBI grade 1＿5 points)could benefit from TACE+SORA(median PFS: 11.8 months vs 7.0 months,P=0.000;median OS: 27.6 months vs 23.0months,P=0.019).Compared with TACE alone,the combined strategy could not significantly benefit patients with liver function of ALBI grade 2＿grade B(median PFS: P=0.370;median OS: P=0.131).ALBI grades was superior to Child-Pugh grades in predicting the survival of patients with HCC.3.There was no significant difference in median OS between TACE +SORA group and TACE group in patients with relatively small tumor burden(tumor load layer 1: P>0.05).The median OS of TACE + SORA group was significantly higher than that of TACE group in HCC patients with tumor load of 2 and 3 layers(layer 2: 24.5 months vs 18.5 months,layer 3: 15.0 months vs 12.2 months;P<0.05).4.Treatment regimens,albumin level,ALBI grades,Child-Pugh grades,tumor burden,intrahepatic metastasis and extrahepatic metastasis were independently associated with the prognosis of HCC patients.The C index and AUC of the nomogram prediction model based on ALBI grades and Child-Pugh grades were 0.846 and 0.703,respectively.Nomograph model based on ALBI grades were better than nomograph model based on Child-Pugh grades(0.844 vs 0.839).It also performed well in predicting OS in1,2 and 3 years(C index range: 0.707-0.928).Based on the nomogram model,patients could be divided into three groups : < 62 points(high risk),≥ 62 and< 104 points(medium risk),≥ 104 and < 180 points(low risk).5.The PFS of patients receiving immunotherapy combined with antiangiogenic therapy and TACE were better than that of patients receiving immunotherapy combined with antiangiogenic therapy or TACE(P=0.001).Patients with liver function of ALBI grade 1,Child-Pugh grade 5 and tumor burden of layer 2 receiving immunotherapy combined with antiangiogenic therapy and TACE could significantly improve the prognosis of patients(P values of median PFS were all < 0.05;median OS was not reached).Conclusions:1.The survival benefit of TACE combined with sorafenib is better than that of TACE alone in patients with advanced liver cancer and recurrent primary liver cancer after radical surgery.2.Compared with TACE alone,patients with good liver function reserve(ALBI grade 1＿5 points)can benefit significantly from TACE combined with SORA;for patients with poor liver function(such as ALBI grade 1＿grade B),combined therapy can not significantly prolong the survival of patients with liver cancer.ALBI grades is superior to Child-Pugh grades in predicting the prognosis of HCC.3.The prognosis of patients with large tumor burden((layer 2 and layer 3)is better than that of patients with TACE alone.4.The nomogram prediction model can predict the prognosis of patients with unresectable liver cancer and patients with recurrence of liver cancer,and it is also a good risk stratification model.Nomograph model based on ALBI grades is better than nomograph model based on Child-Pugh grades.5.Compared with immunotherapy combined with antiangiogenic therapy or TACE,immunotherapy combined with antiangiogenic therapy and TACE can improve the prognosis of patients,especially in HCC patients with better liver function,such as ALBI grade 1 and Child-Pugh 5points.