Short Term Efficacy And Safety Of TACE Combined With Target Free Therapy In Middle And Advanced Liver Cancer

Objective: Hepatocellular carcinoma(HCC)has a hidden onset,and most patients have reached mid to late stages of diagnosis,losing the opportunity for radical surgical treatment.If not treated in a timely manner,the prognosis is very poor.For mid to late stage HCC,intervention therapy combined with systemic anti-tumor therapy is currently the mainstream in China,supplemented by radiotherapy and traditional Chinese medicine treatment.The triple therapy regimen of interventional therapy combined with targeted immunotherapy has shown good clinical application prospects,but currently,there are no clear reports on the treatment of mid to late stage HCC with triple therapy.This study retrospectively analyzed the clinical data of mid to late stage HCC patients who received transcatheter arterial chemoembolization(TACE)combined with targeted therapy and immunotherapy and single TACE treatment at Liuzhou People’s Hospital,and compared the short-term efficacy and safety differences between TACE combined with targeted immunotherapy and single TACE treatment for mid to late stage HCC,To evaluate the prognosis of mid to late stage HCC patients receiving TACE combined with targeted immunotherapy,providing more basis for the selection of treatment plans for this group of mid to late stage HCC patients in clinical work.Methods:(1)Collect the relevant medical records of patients with advanced HCC who were diagnosed in Liuzhou People’s Hospital from June 1,2020 to May 31,2022,including gender,age,smoking history,hepatitis B history,alanine aminotransferase(ALT),aspartate aminotransferase(AST),abnormal prothrombin,alpha fetoprotein(AFP),tumor number,Child Pugh grade CNLC staging,ascites,cirrhosis,lymph node metastasis,and intrahepatic metastasis.(2)Eligible patients were divided into two groups according to treatment modality,including TACE combined with target free group and single TACE group.(3)Response evaluation criteria in solid tumors 1.1(RECIST 1.1)was used to evaluate the tumor response and to compare the objective response rate(ORR)and disease control rate(DCR)between the two groups.(4)Progression free survival(PFS)was analyzed and compared between the two groups using the Kaplan-Meier method,Log-rank test.(5)Univariate and multivariate analyses of possible prognostic factors for PFS were performed using Cox proportional hazards regression models.(6)Patients’ related adverse events(AEs)that occurred after antineoplastic treatment were recorded,and the incidence of AEs was compared between the two groups to assess differences in the safety of the two treatments.Results: A total of 97 patients were included in this study.Fifty five patients(56.7%)received TACE combined with target immunotherapy and 42 patients(43.3%)received single TACE therapy.(1)The baseline data(including gender,age,smoking history,hepatitis B history,ALT,AST,abnormal prothrombin,AFP,number of tumors,Child Pugh grade,CNLC stage,ascites,cirrhosis,lymph node metastasis and intrahepatic metastasis)of the two groups were not statistically significant(all P>0.05).(2)After 12 weeks of the first anti-tumor treatment,the treatment efficacy of 97 patients was evaluated according to the RECIST 1.1standard.The ORR of patients in the TACE combined target immunotherapy group and the single TACE group were 71.4% and 29.1%,respectively,with a statistically significant difference(P<0.001);The DCR was 83.3% and 47.3%,respectively,with a statistically significant difference(P=0.002).At the end of the observation,28 patients(66.7%)in the TACE combined target immunotherapy group experienced disease progression,while 47patients(85.5%)in the single TACE group experienced disease progression,with DCR of33.3% and 14.5%,respectively,with a statistically significant difference(P=0.004).(3)According to Kaplan-Meier method and Log-rank test,the median PFS of the TACE combined target immunotherapy group and the TACE single group was 346 days and 157 days,respectively,with a statistically significant difference(P<0.05).(4)Univariate analysis showed that Child-Pugh grade(P=0.027),lymph node metastasis(P=0.020),and treatment methods(P<0.001)all affected the progression free survival of the two groups of patients.Factors with P<0.1 in univariate analysis,including Child-Pugh grade,lymph node metastasis,and treatment style,were included in multivariate analysis.The results showed that Child-Pugh grade(P=0.039),lymph node metastasis(P=0.039),and treatment style(P<0.001)were independent prognostic factors for PFS.(5)There were no complete remission cases and no treatment-related deaths in either group.In the TACE combined target immunotherapy group,37 patients(88.1%)experienced AEs,while in the TACE alone group,49 patients(89.1%)experienced AEs.The difference in the overall incidence of AEs between the two groups was not statistically significant(P=0.878),and the difference in the incidence of various AEs between the two groups was also not statistically significant(all P>0.05).Conclusion:(1)Compared with single TACE,TACE combined with target immunotherapy improves ORR and DCR and improves survival benefit in patients with moderately advanced HCC.(2)Single TACE treatment,Child-Pugh grade B and lymph node metastasis were independent risk factors for PFS.(3)TACE combined with target immunotherapy for middle advanced HCC was safe and tolerable.TACE combined with target immunotherapy did not significantly increase the incidence of AEs compared with the single TACE group.