Efficacy And Safety Of Transcatheter Arterial Chemoembolization Combined With Lenvatinib In Unresectable Hepatocellular Carcinoma

Objective: To investigate the efficacy of transcatheter arterial chemoembolization(TACE)combined with lenvatinib(LEN)versus TACE alone in the treatment of unresectable hepatocellular carcinoma(u HCC).Methods: A retrospective analysis of 93 uHCC patients treated in our hospital between June 2019 and December 2022.44 patients received TACE combined with lenvatinib in the observation group(TACE-LEN group),and 49 patients who received TACE alone were enrolled as the control group(TACE group).By using propensity score matching((PSM)with 1:1 ratio,28 pairs of patients with good balance between groups were matched to reduce evaluation bias.The study endpoints were overall survival(OS)and disease progression-free survival(PFS).Cox regression model was used to determine the independent factors affecting PFS and OS,At the same time,the tumor response and safety were compared between the two groups.This study aims to explore the efficacy and safety of TACE combined with levavatinib in the treatment of unresectable HCC.Results: The median PFS and median OS in TACE-LEN group were significantly longer than those in TACE group(PFS 9.9 months vs 7.3 months,respectively,p=0.01,OS 17.5 months vs 11.9 months,respectively,p=0.041);Treatment modality was an independent factor affecting PFS(hazard ratio [HR]=0.389,p=0.012),and treatment modality and alanine aminotransferase level(ALT)were independent prognostic factors for OS(HR=0.521,p=0.018;HR=2.018,p=0.011);The objective response rate(ORR)in the TACE-LEN and TACE groups was 29.4% and 18.4%,respectively(p=0.205),The disease control rate(DCR)was 88.6% and 77.6%,respectively(p=0.157).In the propensity score-matched cohort(28 pairs),median PFS and median OS in TACE-LEN group were still better than those in TACE group(PFS 10.2 months vs.5.5 months,p=0.0053,OS 17.9 months vs.11.2 months,respectively,p=0.014);Treatment modality was an independent factor for PFS(HR=0.413,p=0.007),and treatment modality and hepatitis B virus(HBV)infection were independent prognostic factors for OS(HR=0.383,p=0.009;HR=0.320,p=0.008);The ORR between the TACE-LEN and TACE groups was 28.6% and18.3%,respectively(p=0.193),The DCR was 85.7% and 75.0%,respectively(p=0.313).29 patients(65.9%)had adverse events related to TACE-LEN,Grade3 / 4 adverse events 8(18.2%).27 patients(55.1%)experienced adverse events related to TACE,5 had grade 3 / 4 adverse events(10.2%).The most common adverse reactions in both groups were abdominal pain(18.2 vs.18.4%,p=0.871),and abnormal liver function(13.6 vs.10.2%,p=0.319).In addition,both groups had fever,diarrhea,fatigue,pneumonia,hypertension,and hypothyroidism adverse effects,which were not statistically significant.Conclusion: TACE combined with lenvatinib is a safe and feasible combination therapy for patients with unresectable HCC and has a better survival benefit than TACE alone.