Efficacy And Safety Evaluation Of HBV Associated Hepatocellular Carcinoma Conventional TACE Combined With Antiviral Therapy

Objective To study the TACE(transcatheter arterial chemoembolization)combined with antiviral therapy in patients with HCC(heatocellular carcinoma)in the clinical curative effect.Methods Through the retrospective study,we continued collecting 100 cases of in patients treated with conventional in Oncology depaterment in People’s Hospital of Tibet Autonomous Region in January 2015 to December 2017,based on conventional TACE patients overall curative effect analysis,analysis of prognostic factors,antiviral curative effect.According to whether patients with antiviral treatment was divided into randomly,antiviral treatment group(treatment group)and without antiviral treatment group(control group),48 cases of treatment group,the control group 52 cases,the treatment group in the hepatic artery chemotherapy embolism with conventional therapy on the basis of joint nucleotide analogs antiviral therapy and control group in line with conventional treatment alone.survival rate and survival curve,HBV turn rate and activation rate,AFP,ECOG,Liver function changes,Child-Pugh,classification of two groups of patients before and after treatment,solid tumor curative effect,the time of disease progression.Using SPSS20.0 statistical software for data analysis;Measurement data using MannWhitney test,counting data by chi-square test;As Kaplan Meier survival curve,the survival function of the log-rank test.Kaplan Meier-and application method of single factor analysis,screening prognostic factors,and survival curve drawing,and multifactor analysis,using COX regression filter to had independent prognosis factors;P<0.05 there were significant differences.Results(1)Liver function of the two groups: ALT,AST,ALB and TBIL were significantly improved with the duration of treatment,and the difference was statistically significant(P<0.05).There was no significant change in PT level with the duration of treatment(P>0.05).(2)The DNA level of HBV in the treatment group decreased gradually with the duration of treatment,and the difference between treatment group and TACE group was statistically significant(P<0.05).The undetectable rate of HBV DNA in the treatment group was 2,4 and 6 months were 20.83%,43.75% and 60.42% after treatment.The undetectable rate of HBV DNA in the matched group was 2,4 and 6 months were 8.82%,2.94% and 5.88% after treatment.The activation efficiency of HBV DNA in the treatment group was 2,4 and 6 months were 10.42%,14.58% and 12.50% after treatment.The activation efficiency of HBV DNA in the matched group was 2,4 and 6 months were 42.31%,50.00% and 55.77% after treatment.(3)After 6 months of treatment,the evaluation effect of solid tumor respectively was different:the ORR of treatment group was 62.50%,the ORR of matched group was 25.00%,The difference between groups was statistically significant(Χ2=6.216;P=0.003).The DCR of treatment group was 87.50%,the DCR of matched group was 61.54%,The difference between groups was statistically significant(Χ2=12.836;P=0.001).(4)End of follow up,there were 22 cases(45.83%)of the patients survived,and 26(54.17%,Including lost to follow-up)died in treatment group.There were 20 cases(38.46%)of the patients survived,and 32(61.54%,Including lost to follow-up)died in matched group.The median OS of treatment group was 23 months [95%CI:21.198~24.802].The median OS of treatment group was 12 months [(95%CI:9.915~14.085)].The difference between groups was statistically significant(Χ2=9.827,P=0.002).The median OS of treatment group was 23 months [95%CI:12.151~15.849].The median PFS of treatment group was 8 months [95%CI:5.760 ~ 10.240].The difference between groups was statistically significant(Χ2=8.266,P=0.004).(5)The kaplan-meier method was used to analyze the factors:The 10 prognostic factors of AFP,ALT,AST,iodine oil deposition,abdominal water volume,portal vein cancer suppository,extrahepatic metastasis,serum HBV DNA,clinical staging and antiviral treatment were statistically significant(P<0.05).But 9 prognostic factors of TBIL,PT,ALB,ECOG,Gender,age,tumor size,number,and cirrhosis had no statistical significances(P>0.05).(6)There were 10 variables were selected into the Cox proportional hazards modeinclude AFP,ALT,AST,water iodine oil deposit,abdomen,portal vein tumor emboli,extrahepatic metastasis,and serum HBV DNA,clinical staging and antiviral treatment,using stepwise regression method.The significance test of the COX model was demonstrated by likelihood ratio,and obtaine the variables of statistical significance statistically significant variables(B),standard error(SE)and risk ratio(Exp(B))and Exp(B)the confidence interval(95% CI for Exp(B)).Multi-factor analysis results showed: the factors of Clinical stage,extrahepatic metastasis,iodine oil deposition degree and antiviral therapy were statistically significant(P<0.05).But the factors of ALT,AFP,ALB,ALT,AST,portal cancer suppository,ascites had no statistical significances(P>0.05).The relative risk of HBV DNA load,clinical staging,and extrahepatic metastasis were 0.835,0.820,and 0.299,respectively,<1,which is a risk factor.The relative risk of the degree of iodine oil deposition and antiviral therapy were 2.727,3.321 and >1,which was the protective factor.Conclusion(1)For improving the short-term curative effect of liver cancer,improving long-term survival rate and prolonging survival time,entecavir anti-virus combined with TACE group was superior to TACE alone group;(2)In the clinical treatment of patients with primary liver cancer,active anti-virus can improve the liver function damage after TACE,prevent the further activation of hepatitis B virus,improve its long-term efficacy,and provide a clinical reference for the antiviral treatment of primary liver cancer in our hospital.