Exploring The Clinical Study Of HAIC-based Combination Therapy In Intermediate Stage Hepatocellular Carcinoma Based On Bolondi Staging

Purpose:Depending on the tumor burden and liver function status,mid-stage hepatocellular carcinoma can be restaged by Bolondi criteria.In recent years,transhepatic artery infusion chemotherapy,targeted therapy and immunotherapy have achieved good results in the treatment of hepatocellular carcinoma.The purpose of this paper is to explore the clinical value of HAIC-based combination therapy in mid-stage hepatocellular carcinoma based on Bolondi staging.Method:A total of 83 patients with Barcelona Clinic Liver Cancer(BCLC)stage B liver cancer who did not receive surgical treatment between October 1,2019 to October 1,2022 at the First Affiliated Hospital of Nanchang University were collected.The Bolondi stage was performed acsubcording to tumor load,liver function status,Eastern Cooperative oncology Group(ECOG)personal physical status(PS)score and portal vein cancer thrombosis.Four subgroups were subdivided:group B1(n=16 patients),group B2(n=35 patients),group B3(n=21patients)and group B4(n=11 patients).The clinical data of all patients were followed up and recorded,including:baseline data,laboratory tests,and imaging examinations.The immediate efficacy of patients in each group was evaluated according to the m RECIST criteria,and the long-term efficacy and survival analysis results of patients in each group were evaluated using the progression free survival(PFS)time.The Kaplan-Meier method was used to depict the survival curves of each group,and the Log-Rank test was used to compare between groups.All indicators that might affect the patients’PFS were included in the univariate and multifactorial Cox regression analyses.All indicators that might affect the patients’PFS were included in the univariate and multifactorial Cox regression analyses.All statistical analyses were performed by SPSS 26.0software,and Kaplan-Meier survival curves were plotted by the software Graphpad Prism 8.P-value?<?0.05 was taken as statistically significant.Result:For near-term efficacy:the ORR was higher in the B2+B3 group than in the B1 group(x~2=6.208,P<0.017).For the long-term PFS analysis:patients in group B1 had higher m PFS than group B2(11.5 months vs.9.2 months,P=0.030),higher than group B3(11.5 months vs.8.8 months,P=0.042),and higher than group B4(11.5 months vs.6.8 months,P<0.001).There was no statistical difference in PFS between group B2 and group B3(9.2 months vs.8.8 months,P=0.752),no statistical differences were observed between the group B3 and group B4(8.8 months vs.6.8 months,P=0.066).The results of Cox univariate analysis showed that the maximum tumor diameter(P<0.001,HR=1.123,95%CI:1.050-1.201),AFP(P=0.010,HR=1.935,95%CI:1.171-3.198),GGT(P=0.017,HR=1.002,95%CI:1.000-1.004)and Bolondi stage(P<0.001,HR=1.565,95%CI:1.197-2.046)were associated with PFS.Based on the Cox multifactor analysis,it was found that the Bolondi stage(P=0.029,HR=1.405,95%CI:1.035-1.908)and maximum tumor diameter(P=0.027,HR=1.085,95%CI:1.009-1.167)were independent risk factors affecting PFS in patients with intermediate stage liver cancer.Conclusion:1.In terms of near-term efficacy,HAIC-based combination therapy has good shrinkage effect on mid-stage hepatocellular carcinoma,among which the near-term ORR of patients with stage B2 and B3 can reach over 60%;2.In terms of long-term efficacy,the m PFS of patients with stage B1-B4 liver cancer treated with HAIC-based combination therapy were 11.5 months,9.2months,8.8 months and 6.8 months.Maximum tumour diameter and Bolondi stage were independent risk factors for PFS in patients with intermediate stage liver;3.Bolondi staging is informative in predicting the prognosis related to PFS in patients with HAIC-based combination therapy for mid-stage hepatocellular carcinoma.However,there were limitations in PFS in stage B2 vs.stage B3 and stage B3 vs.stage B4(P>0.05).