Analysis Of The Mid-term Efficacy Of TACE Combined With Terelizumab And Lenvatinib In The Treatment Of ’ TACE Resistant ’ Liver Cancer

Objective :The purpose of this research was to retrospectively study the patients with advanced liver cancer who were treated in the interventional department of a hospital.When ’ TACE resistance ’occurred during the treatment process,the efficacy and safety of TACE combined with tirelizumab and lenvatinib compared with TACE alone were discussed.Materials and Methods :A total of 58 patients with advanced liver cancer who had ’ TACE resistance ’ after TACE treatment in the interventional department of a hospital from March 2020 to May 2022 were collected.According to the inclusion and exclusion criteria,a total of 44 patients were selected.The patients who continued to receive TACE combined with temalizumab and lenvatinib were set as the experimental group,and the patients who continued to receive TACE on demand were set as the control group,including 22 patients in the experimental group and 22 patients in the control group.The electronic medical record was used to collect the clinical baseline data of the enrolled patients,and the patients were followed up by outpatient,inpatient review,telephone,etc.The followup deadline was March 3,2023,and the patient died during the follow-up period or until the follow-up deadline was the follow-up endpoint.Two independent samples t test,chi-square test and rank sum test were used to compare the clinical baseline indicators,objective response rate(ORR)and adverse events(AEs)between the two groups before enrollment.The m RECIST standard was used to evaluate the short-term efficacy of tumors.The primary endpoint was progression-free survival(PFS),and the secondary endpoint was overall survival(OS),ORR and safety.The Kaplan-Meier curves of PFS and OS in the two groups were drawn by SPSS 24.0 software.The survival curves were compared by Log-rank test.The PFS rate and OS rate were compared by Z test.COX proportional hazard regression model was used to analyze the prognostic factors of PFS.Results :1.There were no statistically remarkable clinical measures between the two groups,laboratory examination indicators,TACE times before TACE resistance,and disease time before TACE resistance between TACE + lenvatinib + lenvatinib group and TACE group(P > 0.05).2.Comparison of tumor response,during the follow-up period,the tumor response of TACE + tirelizumab + lenvatinib group was significantly better than that of TACE alone group,with significant statistical significance(Z =-2.317,P = 0.021 < 0.05).3.The results of Kaplan-Meier curve showed that there were significant differences in PFS and OS survival curves between the two groups(P < 0.05).The median PFS of the control group and the experimental group were 5.0 months(95 % CI : 4.084-5.916)and 8.0months(95 % CI : 7.010-8.990)(P < 0.001).The 6-month and 9-month PFS rates in the experimental group were higher than those in the control group(95.5 % VS 27.3 %,P = 0.046;43.2 % VS 13.6 %,P =0.030).When the patients were followed up to 12 months,the PFS rate ratio of the experimental group and the control group was 20% vs 4.8%(3/15 vs 1/21).At 15 months,the ratio was 13.3% vs 0(2/15 vs 0/21).At 18 months,the ratio was 6.7 % vs 0(1/15 vs 0/21).The median OS of the control group was 9 months,and the median OS of the experimental group was not reached.The 6-month OS rate of the experimental group and the control group was similar(100% vs 95.5%,P=0.236).The 9-month OS rate of the experimental group was significantly higher than that of the control group(95.5% vs 31.8%,P =0.012),and the difference was statistically significant.When the patients were followed up to 12 months,the OS rate ratio of the experimental group and the control group was 77.8% vs 9.5%(7/9 vs2/21).At 15 months,the ratio was71.4 % vs 4.8%(5/7 vs 1/21).At 18 months,the ratio was 42.9 % vs 0(3/7 vs 0/21).4.Variables such as tumor number,maximum tumor diameter,vascular invasion,distant metastasis,and ECOG score were included.Univariate COX regression analysis showed that AFP level and choice of treatment were independent predictors of PFS(P < 0.05).Multivariate COX proportional hazard model was constructed.The statistical results showed that AFP level(AFP > 400 vs AFP ≤ 400)(HR=0.437,95.0%CI 0.193-0.987,P = 0.046),treatment method(TACE vs TACE +tirelizumab + lenvatinib)(HR = 0.188,95.0 % CI 0.078-0.454,P <0.001)were the independent predictors of PFS,and the influence of other variables on PFS was not statistically significant(P > 0.05).5.Comparison of adverse reactions,no severe adverse events(grade 4 or above)occurred in all patients.However,there was no difference in embolism-related syndromes between the experimental group and the control group.The incidence of hypothyroidism in the experimental group was obviously higher than that in the control group(31.8 % vs 9.1 %),without significant between group differences.(χ2= 2.235,P = 0.135 > 0.05).Conclusion :TACE combined with tirelizumab and lenvatinib is superior to TACE alone in the treatment of ’ TACE-resistant ’ liver cancer PFS,which is conducive to controlling tumor progression and improving quality of life.