Retrospective Clinical Study Of TACE Combined With Apatinib In The Treatment Of Advanced Hepatocellular Carcinoma

Objective:This study compared transarterial chemoembolization(TACE)combined with apatinib and TACE alone in the treatment of advanced hepatocellular carcinoma(HCC).The short-term efficacy,long-term prognosis and safety of TACE combined with apatinib in the treatment of advanced HCC were retrospectively analyzed,and the factors that may affect the prognosis of the combined group were analyzed to provide clinical data support for this new technology.Methods:62 patients with advanced HCC who were treated in the First Affiliated Hospital of Kunming Medical University from January 2016 to March 2016 were included in the study.TACE plus apatinib was performed in 32 patients while TACE monotherapy was performed in 30 patients.All patients were followed up every month after treatment,and the follow-up time was 36 months.The postoperative alpha-fetoprotein(AFP),object response rate(ORR),adverse reactions,progression-free survival(PFS),overall survival(OS)and survival rate were compared.This study also analyzed all factors which may aflfect the PFS of TACE combined with apatinib.The statistical software SPSS 17.0 was used and P<0.05 was statistically significant.Results:At 3 and 6 months after treatment,the ORR of TACE plus apatinib group were 62.5%and 53.1%respectively while 33.3%and 23.3%in TACE alone group respectively,the differences were statistically significant(P<0.05);the AFP levels decreased obviously in two groups 3 months after treatment,the AFP level was 104.7(29.5,200.7)ngInl in TACE plus apatinib group while 110.8(48.9,205.1)ng/ml in TACE alone group,there was no statistical difference(P>0.05);when compared with the AFP levels before treatment in each group,the differences were statistically significant(P<0.05);the mPFS was 14 months in TACE plus apatinib group while 7 months in TACE alone group,the difference was statistically significant(P<0.05);the mOS was 20 months in TACE plus apatinib group while 11 months in TACE alone group,the difference was statistically significant(P<0.05);the 1,2 and 3 year survival rate of TACE plus apatinib group were 75.0%,40.6%and 25.0%respectively while 46.7%,16.7%and 3.3%in TACE alone group respectively,the differences were statistically significant(P<0.05);there were no significant differences in the incidence of embolism syndromes between the two groups(P>0.05)while the incidence rate of adverse reactions of apatinib in TACE plus apatinib group were significantly higher than that in TACE alone group,and the differences were statistically signifieant(P<0.05);in TACE plus apatinib group,the mPFS in patients with BCLC B was 18 months while 8 months in patients with BCLC C,the difference was statistically significant(P<0.05);the mPFS in patients with AFP<400ng/ml was 16 months while 11 months in patients with AFP?400ng/ml,the difference was statistically significant(P<0.05);the mPFS in patients with hypertension was 18 months while 10 months in patients without hypertension,the difference was statistically significant(P<0.05);the mPFS in patients with proteinuria was 19 months while 12 months in patients without proteinuria,the difference was statistically significant(P<0.05);the mPFS in patients with hand and foot syndrome was 16 months while 9 months in patients without hand and foot syndrome,the difference was statistically significant(P<0.05);BCLC staging and hypertension were the independent prognostic factors affecting PFS of TACE plus apatinib group.Conclusion:1.In the treatment of advanced hepatocellular carcinoma,TACE combined with apatinib can improve the objective response rate and survival rate and prolong the progression-free survival and overall survival compared with TACE alone;2.Both of TACE combined with apatinib and TACE alone can reduce AFP effectively in patients with advanced hepatocellular carcinoma,no significant difference;3.The treatment of TACE combined with apatinib in advanced hepatocellular carcinoma has a higher safety;4.BCLC staging and AFP levels are factors affecting the progression-free survival of patients treated with TACE combined with apatinib.Patients with BCLC C and pre-treatment AFP?400ng/ml have poor prognosis;5.Patients with hypertension,proteinuria and hand foot syndrome have good prognosis,which has the same conclusion as relative research.