Clinical Analysis Of Apatinib And Apatinib Combined With TACE In Treatment Of Advanced Hepatocellular Carcinoma

Background and Purpose Hepatocellular carcinoma(HCC)is one of the leading causes of cancer morbidity and mortality in China.Many patients are diagnosed in the advanced stage.Sorafenib can still achieve certain effects and prolong the overall survival time for patients with advanced HCC,but there are some disadvantages such as limited benefit,high cost and obvious adverse reactions.Currently,there is still a lack of safe and effective treatment options for patients with advanced HCC.Apatinib is a new type of oral small molecule anti-angiogenic agent.The phase II clinical trial has achieved encouraging results.Phase III clinical trial is ongoing actively.The pathogenesis of advanced HCC is complex,and the effect of single therapy is maybe limited.Domestic and foreign scholars have made active explorations on the combination treatment of intermediate and advanced HCC.However,there are relatively few comparative studies on Apatinib alone and Apatinib combined with transcatheter arterial chemoembolization(TACE)in treatment of advanced HCC.This study retrospectively analyzes the patients with advanced HCC in our hospital in June 1,2016 to August 1,2017 to preliminarily explore the short-term effect,changes of AFP,progression-free survival time and adverse reactions of Apatinib and Apatinib combined with TACE in treatment of patients with advanced HCC.Data and Method From June 1,2016 to August 1,2017,59 patients with pathological or clinical diagnosis of advanced HCC in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed,31 patients were treated with Apatinib combined with TACE,and 28 patients were treated with Apatinib.The clinical efficacy and adverse reactions of the two groups were analyzed.Statistical Method SPSS 23.0 statistical software is used to analyze the data of patients treated with Apatinib and Apatinib combined with TACE.Categorical data are analyzed by chi-square test or Fisher's exact test.The survival curves of two groups are drawn by the kaplan-Meier method,and the survival curves of the two groups are compared by the Log-rank method.P<0.05 is considered to be statistically significant.Results 1.According to the m RECIST standard: Single drug treatment group: no cases reached complete response,PR accounted for 21.43%(6/28),SD accounted for 35.71%(10/28),PD accounted for 42.86%(12/28),ORR accounted for 21.43%,DCR accounted for 57.14%.Combination treatment group: no cases reached complete response,PR accounted for 61.29%(19/31),SD accounted for 22.58%(7/31),PD accounted for 16.13%(5/31),ORR was 61.29%,DCR was 83.87%.2.Comparison of the short-term efficacy in the single drug treatment group and the combination treatment group: ORR of the combination treatment group was 61.29%,which was statistically significant compared with the single drug treatment group,61.29% vs.21.43%,P<0.05.DCR of the combination treatment group was 83.87%,which was statistically significant compared with the single drug treatment group,83.87% vs.57.14%,P<0.05.3.Comparison of AFP changes between the single drug treatment group and the combination treatment group: In the single drug treatment group,patients with AFP decreased by more than 50% accounted for 46.43%(13/28).In the combination treatment group patients with AFP decreased by more than 50% accounted for 74.19%.the difference between the two groups was statistically significant,46.43% vs.74.19%,P<0.05.4.Progression-free survival: The median PFS of the single drug treatment group is 4.1 months(95%CI: 1.26~6.95 months),and the median PFS of the combination treatment group is 8.4 months(95%CI: 7.02~9.78 months).The difference in PFS between the two groups is statistically significant,P<0.05.5.Hypertension,hand and foot syndrome and gastrointestinal reactions are the most common adverse reactions in the two groups.The incidence of various adverse reactions is not statistically significant between the two groups,P>0.05.Conclusion 1.Treatment with Apatinib or Apatinib combined with TACE in patients with advanced HCC shows good short-term curative effect and progression-free survival.Adverse reactions can be tolerated.2.Compared with the single Apatinib treatment,Apatinib combined with TACE treatment shows better short-term curative effect and progression-free survival.This study provides the reference for further clinical research.