Clinical Study Of TACE Combined With Low-dose Apatinib In The Treatment Of Advanced Hepatocellular Carcinoma

Objective1.To compare the effificacy of combination treatment of transcatheter arterial chemoembolization with low-dosage apatinib versus TACE alone for intermediate and advanced hepatocellular carcinoma(HCC).2.To analyze the efficacy of TACE plus low dose apatinib for the therapy of patients with intermediate-advanced HCC and evaluate the prognostic impact of clinical characteristics.Materials and methods1.Between June 2016 to June 2019,Data of 229 patients with BCLC B and C stage HCC were bringing into our study,61 patients of them received TACE combined with low-dose apatinib(combination group),and left 168 patients received TACE alone(TACE group).The propensity score matching(PSM)was used to balance the baseline data of the two groups according to 1:1,and then the clinical effects of the two therapeutic method were summarized and analyzed.2.The complete clinical data of 61 patients with BCLC B and C stage HCC,who received TACE combined with low-dose apatinib in our center from June 2016 to June 2019 were systematically analyzed.First,survival analysis was performed using the life table method,folowed by univariate analysis of survival using the Kaplan-Meier method.Finally,Cox proportional risk regression model was used for multivariate analysis to identify independent prognostic factors affecting survival.Results1.After PSM,a total of 110 cases in both groups were included in the analysis.Before PSM,m OS and m PFS were significantly longer in the combination group than in the TACE group(m OS: 518 days vs.297 days,P = 0.001;m PFS: 310 days vs.103 days,P < 0.001).After PSM,m OS and m PFS were significantly longer in the combination group than in the TACE group(m OS: 461 days vs.279 days,P = 0.023;m PFS: 286 days vs.100 days,P < 0.001).After 3 months' treatment,the objective response rate and disease control rate in the combination group were both higher than those in the TACE group(69.1% vs 32.7%,P < 0.001;83.6% vs 54.5%,P =0.001).The most common apatinib-related adverse events were hypertension(41.8%)and hand-foot syndrome(36.4%),and that grade 3 AEs occurred in only 5patients(9.1%)in the combination group.2.The 0ne-year,two-years,3-years of cumulative survival rates for 61 patients were respectively 64%,33% and 16% and the m OS was 17.3 months,the m PFS was10.3 months.The COX regression model risk multivariate analysis indicates that ECOG PS score,extrahepatic metastasis,number of TACE,apatinib-related hypertension,apatinib-related HFSR and treatment cycle of apatinib are independent factor for survival.Conclusion1.TACE combined with low-dose apatinib can ameliorate the tumour response and prolong the survival of HCC patients with tolerable toxicity comparing to TACE alone.2.The clinical efficacy of TACE combined with low-dose apatinib in the treatment for intermediate-advanced HCC is satisfactory,and the independent prognostic factors are ECOG PS score,extrahepatic metastasis,number of TACE,apatinib-related hypertension,apatinib-related hand-foot syndrome and treatment cycle of apatinib.