| BackgroundPrimary liver cancer(PLC)is one of the most common malignant tumors worldwide.Both the incidence and mortality of PLC in China accounts for over 50%of these in the word,seriously threatenings the lives and health of the Chinese people.Liver cancer has the characteristics of occult onset and atypical early symptoms,which makes the results that most patients were already in advanced stages of illness at the time of consultation,and consequently there were no chances for surgery.With the development of medical technology,the treatment of liver cancer tends to be diversified and complex,however it is still difficult to effectively improve the overall survival rate of patients.The patients with advanced liver cancer have a poor prognosis,moreover the median overall survival time is usually less than 1 year.The Transcatheter arterial chemoembolization(TACE)is currently one of the most commomly used treatments for patients with non-surgical liver cancer.The TACE kills tumor cells by embolizing tumor blood supply vessels and injecting tumor chemotherapy drugs,while cannot completely block blood vessels,moreover the tumor cells release a large amount of vascular endothelial growth factor(VEGF)during hypoxia,promoting the proliferation of tumor cells and the formation of new blood vessels.Therefore,TACE treatment still has a higher recurrence and metastasis rate.The inhibition of tumor angiogenesis plays an important role in improving the prognosis of TACE patients.Sorafeni and Apatinib are commonly used VEGFR related TKI in clinic,which can effectively inhibit tumor angiogenesis.Theoretically,the combination treatment with TACE may improve the prognosis of patients with advanced liver cancaer more effectively.ObjectiveThe clinical effects and safety of TACE combination therapy with Sorafenib and Apatinib in patients with advanced liver cancer were retrospectively analyzed,while provided new ideas for the selection and optimization of treatment options for patients with advanced liver cancer.MaterialsCollecting the complete medical records of patients with advanced liver cancaer from June 2016 to January 2019 in the First Affiliated Hospital of Zhengzhou University.A retrospective cohort study method was used with the help of the SPSS 24.0 software.A caliper test or Fisher's exact test was used to test whether the baseline characteristics,recent efficacy,and long-term efficacy of the two groups of patients were There were statistical differences.Differences in adverse effects between the two groups were compared by chi-square test.Overall survival and progression-free survival were performed using the Kaplan-Meier method.Single-factor survival analysis was performed using Kaplan-Meier,and statistically significant single factors were included in the COX ratio Multi-factor analysis in risk models The difference was statistically significant when P<0.05.Results1.Clinical efficacy:Short-term efficacy:The objective response rate(ORR)of the TACE combined with sorafenib(hereinafter referred to as sorafenib group)was 39.4%,the disease control rate(DCR)was 84.8%;while the ORR and DCR of the TACE combined with apatinib group(hereinafter referred to as apatinib group)was 28.6%and 77.1%respectively.There was no significant difference in ORR and DCR between two groups(P=0.346,P=0.419).Long-term efficacy:The average PFS of the sorafenib group and the apatinib group was 10.32 months and 8.26 months respectively,while the median PFS was 8.0 months and 7.0 months.In addition,the two groups has an mean OS of 24.03 months and 23.97 months repectively,while the median OS was 17.0 months and 14.0 months.There was no significant difference in the OS and PFS between the two groups(P=0.508,P=0.371).After treatment,the AFP level of the two groups of patients decreased significantly,and the difference before and after was statistically significant.2.Adverse reactions:All patients had varying degrees of drug-related adverse reactions,while no grade 4 adverse reactions occurred,as well as the drug-related deaths.The incidence of hand-foot syndrome and hypertension in apatinib group was higher than in sorafenib group,and the differences were statistically significant(P=0.029,P=0.030).There were no significant differences in the other adverse reactions.All adverse reactions were relieved after symptomatic treatment or adjustment of drug dosage.3.Influencing factors:Influencing factors related to prognosis include age,BCLC stage,Child Pugh grade,AFP level,and HBV virus replication.Prognostic factors related to univariate analysis were incorporated into the COX proportional hazard regression model for multivariate analysis.The results show that the factors related to overall survival were BCLC stage and HBV virus replication,which means that hepatitis B virus replication,tvascular invasion,and distant metastasis are positively related to the risk of death.4.Economic benefits:the difference between the two protocols in this study was not statistically significant in terms of near-term and long-term efficacy,so least-cost analysis was used.(CMA)for comparison.Oral sorafenib cost $380/day and apatinib $345/day.The cost of the apatinib group was slightly lower than the sorafenib group when efficacy was similar and safety was similar.Conclusion1.The combination therapy of TACE with sorafenib or apatinib can effectively improve the prognosis of patients with advanced liver cancaer,while there was no significant difference between the two combined treatment options.The cost of treatment was slightly higher in the sorafenib group than in the apatinib group.2.Hand-foot syndrome and hypertension were more likely to occur in the apatinib group.There were no statistically significant differences in other adverse reactions.In addition,both of the therapy are safe.3.The influential factors related to the prognosis of patients were age,BCLC stage,Child Pugh grade,AFP level,and HBV virus replication.In addition,hepatitis B virus replication,vascular invasion,and distant metastasis are positively correlated with the risk of death. |
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