Prophylaxis And Treatment Of Recurrence After Resection Of Hepatocarcinoma By Licartin Infused Via Portal Vein Infusion Pump Combined With TACE:an Clinical Study

ObjectivePrimary liver cancer (PLC) was one of the most common cancer in the world. For the cancer death, it was the third highest in the world, but the second in China. The average survival time for patients with untreated was about 3 months. There were many treatments in liver cancer, such as operation treatment, interventional therapy, chemotherapy, biological therapy and traditional Chinese medicine therapy. Radical liver resection was the most effective treatment for PLC, but the recurrence rate after operation was still very highly. The recurrence and metastasis of PLC were the key factor affecting the long-term survival of patients, so how to prevent the recurrence, prolong the survival time became a focus in nowadays cancer research. Transarterial chemoembolization (TACE) now has become the main method for the unresectable PLC, and which had been recognized by many doctors. But it was still limited to prolong overall survival of patients with curative effect. Licartin, which is a kind of molecular targeted agents, has good effect to prevent recurrence of liver cancer. How to combine Licartin with operation, interventional therapy and chemotherapy treatments effectively to improve the efficacy of treatment, prolong the survival time of the patients, it was still need further research and exploration. The purpose of this study was to compare the curative effect of Licartin infused via portal vein infusion pump combined with TACE and Licartin used only after radical resection of liver cancer. We wanted to find a better way for the treatment of liver cancer, and to improve the postoperative long-term survival, curative effect of surgical treatment to solve the bottleneck of the poor long-term.Materials and methodsAt first, we collected the clinical information of patients, who were underwent radical resection of liver cancer in the first Department of Hepatobiliary, the First People’s Hospital of Yunnan Province from January 1,2012 to December 31,2013. And then, those patients were divided into TACE combined with Licartin group (experimental group) and Licartin group (control group). According to the inclusion and exclusion criteria, all patients who underwented liver cancer were assessed on admission strictly, a total of 64 people into the group, the test group was 35,29 in the control group. All patients were operated by the same doctor performed radical resection for liver cancer, and the resected specimens were studied pathologically and diagnosed with primary liver cancer. The portal vein infusion pump was placed in operation. A month later of postoperative, all patients were required to return the hospital to review and were underwent Licartin treatment via the portal vein perfusion pump. The experimental group were also underwent TACE after Licartin treatment within a month. We recorded all of adverse reactions, biochemical functions, blood routines, and related adverse agents reactions of patients, and both group of adverse reactions, time to recurrence, overall survival will be controlled. All of the patients were underwent SPECT scans to detect Licartin distribution. Two groups of patients have been outpatient or inpatient follow-up, and were recorded a detailed understanding of the survival of patients, the treatment process and cause of death. The follow-up time was once every 3 months after 1 year (from postoperative 1 month after operation), and once every six months 1 years later. Every follow-up must have CT scan. The end of the follow-up were tumor recurrence, death or to March 31,2015.ResultsIn this study, there were totally 68 patients’ clinical data were collected, of which 65 patients were accorded with the inclusive criteria and finally completed this study, and 3 patients were excluded. The experimental group of 35 cases,29 cases in the control group, and there was no significant difference between the two groups in baseline data. The experimental group Ⅰ/Ⅱ adverse reaction rate was 65.71%, Ⅲ/Ⅳ adverse reactions was 20%; patients in the control group, Ⅰ/Ⅱ or Ⅲ/Ⅳ agents related adverse reaction rates were 41.38% and 3.45%. The control group Ⅰ/Ⅱ, Ⅲ/Ⅳ drug related adverse reactions were lower than the experimental group (P gradeⅠ/Ⅱ=0.024, PgradⅢ/Ⅳ< 0:001).The third day before operation, the first day and the seventh day, RBC, TBIL, ALB, Cr, BUN differences had no statistical significance in both groups (P> 0.05).Blood test in the first day after the infusion showed that the WBC and PLT in both experimental and control group were decreased significantly. The number of experimental group was lower than control group (PWBC=0.042, PPLT=0.015). Assessments of liver function showed that AST and ALT were increased after the infusion in the first days later. The experimental group was higer than control group significantly (PALT=0.032, PAST=0.010).SPECT scanning can observe that radionuclide stored in portal vein infusion pump, the catheter and liver.7 days later, Licartin was geathered in liver obviously, especially the suspicious lesion (especially in some cases, concentration was observed in patients with spleen). Licartin was not observed in thyroid and other organs. Licartin is good at targeting.The average follow-up time of two groups of patients is 34.613 months. All the recurrence were intrahepatic recurrence. The experimental group for the first year,2 years disease-free survival rate were 88.57% and 77.14%, in the control group was 82.76% and 69.97%. The experimental group for the first year,2 years survival rate were higher than that of the control, but the difference was not statistically significant (P one year=0.221, Ptwo year=0.262). The time to recurrence was calculated with Kaplan-Meier. The TTRs in experimental group and control group respectively (33.653+1.210) months and (30.623+1.927) months. The time to recurrence of experimental group was higher than the control group, but the difference was not statistically significant (P=0.161). The overall survival of the experimental group was 35.613 months, the control group for 32.788 months. The overall survival of the experimental group was higher than the control group, but the difference was not statistically significant (P=0.80).ConclusionsIn this study, we evaluated the safety and efficacy of the combination regimen by collecting clinical data of patients’ 1. Licartin used to prevent the recurrence of hepatocellular carcinoma after surgery is safe, less toxic side effect, and patients can be tolerated.2. Licartin has better targeting. 3. Licartin combined with TACE therapy is safe, well tolerated.4. From the present study, we still can not believe that comparing with Licartin used only, Licartin combined with TACE treatment can extend with recurrence and overall survival time of patients.To sum up, in our opinion, the new regimen of Licartin infused via portal vein infusion pump combined with TACE was a safe, effective scheme of the prophylaxis and treatment of recurrence after resection of hepatocellular carcinoma and was worthy of a further study.