Efficacy And Safety Analysis Of PD-1 Inhibitor Combined With Targeted Drugs In The Treatment Of Intermediate And Advanced Hepatocellular Carcinoma

Objective: The purpose of this study is to retrospectively collect the clinical data of patients with advanced primary liver cancer treated in our hospital,analyze and discuss the therapeutic effect and adverse reactions of PD-1 inhibitors combined with molecular targeted drugs in patients with advanced hepatocellular carcinoma,and summarize the relevant experience of our hospital in the diagnosis and treatment of patients with advanced primary liver cancer,In order to better realize the individualized and precise comprehensive treatment of patients with advanced liver cancer,and provide some treatment basis for improving the quality of life and survival time of patients with advanced primary liver cancer.Methods: 50 patients with advanced liver cancer admitted to the hepatobiliary surgery,oncology department and other departments related to liver cancer treatment of Guizhou Provincial People’s Hospital from January 1,2017 to June 30,2021 were retrospectively collected.The general and clinical data of the patients were collected,including gender,age,number of tumors,portal vein tumor thrombus,metastasis,liver cirrhosis,child Pugh grade,HBs Ag,AFP,CNLC stage;The adverse reactions observed included pneumonia,skin rash,gastrointestinal reaction,abnormal liver function,abnormal renal function,hypothyroidism,edema of both lower limbs,hypertension,decreased appetite and joint pain.Inclusion criteria: 1.Pathologically confirmed or clinically diagnosed intermediate and advanced hepatocellular carcinoma;2.Age greater than or equal to 18 years old;3.Child-Pugh score ≤8 points(Child-Pugh A/B);4.CNLC stage is IIB and above;5.At least one measurable lesion;6.ECOG PS 0-2.Exclusion criteria: 1.History of solid organ transplantation or bone marrow suppression;2.Acute autoimmune disease requiring systemic therapy;3.Autoimmune deficiency requiring steroid or other immunosuppressive therapy;4.PD-1 inhibition Drugs and targeted drugs are contraindicated and those who cannot tolerate TACE treatment.They were divided into study group and control group according to different treatment schemes.There were 25 cases in the study group and 25 cases in the control group.The study group was treated with PD-1 inhibitor combined with targeted drugs,and the control group was treated with targeted drugs alone.Both groups were routinely treated with TACE and Sophora japonica granules.The treatment effect was evaluated according to mresist1.1 and resist1.1 efficacy evaluation criteria,the treatment effect and adverse reactions of the two groups were observed,the clinical effects and safety of the two different treatment schemes were analyzed,and spss21.0 was used for statistical analysis.Result:(1)There was no difference in the composition ratio of factors such as gender,age,portal vein tumor thrombus,metastasis,liver cirrhosis,Child-Pugh grade,HBs Ag Yin and Yang,AFP Yin and Yang,,CNLC stage and other factors before treatment among the three groups of patients.Statistical significance,all P>0.05;before treatment,there was no statistical significance in the differences of WBC、ANC、PLT、PT、ALT、TBIL、ALB、CR、BUN among the three groups of patients,all P>0.05.(2)Most of the three groups of patients decreased AFP counts after treatment and the AFP decline rate in the study group was higher than that in the control group(0.17 vs 0.02),and there was a Statistical difference(Z=-2.504,p=0.012,95%CI:-0.09,0.30),And the research group has a larger decline.(3)The median survival time of PD-1 inhibitor combined with targeted drug therapy in the study group was significantly longer than that in the control group(28.0 months vs19.0 months)(P < 0.05).(4)In the study group,the cumulative number of adverse reactions such as pneumonia,rash,gastrointestinal reaction,abnormal liver function,abnormal renal function,hypothyroidism,edema of both lower limbs,hypertension,decreased appetite and joint pain in the PD-1 inhibitor combined with targeted drugs treatment group was 67,and the cumulative number of adverse reactions in the control group was 60.The results of the number of adverse reactions in the two groups were not statistically significant(p>0.05).Conclusion:(1)Compared with molecular targeted drugs alone,PD-1 inhibitors combined with molecular targeted drugs can prolong the survival time of advanced hepatocellular carcinoma.(2)The side effects of PD-1 inhibitor combined with molecular targeted drugs in the treatment of advanced hepatocellular carcinoma did not increase significantly,and the safety was good.