Clinical Analysis Of D-TACE Combined With Microwave Ablation Followed By PD-1 Inhibitor In The Treatment Of BCLC Stage B Primary Liver Cancer

Objective:To compare the safety and clinical efficacy of D-TACE combined with microwave ablation followed by PD-1 inhibitor(D-TACE+MWA+PD-1)and D-TACE combined with microwave ablation(D-TACE+MWA)in the treatment of BCLC stage B primary liver cancer.In order to better realize the individualized and precise comprehensive treatment of patients with BCLC stage B primary liver cancer,and provide certain treatment basis for improving the survival treatment and survival time of patients with BCLC stage B primary liver cancer.Methods:The clinical data of 87 patients with BCLC stage B HCC who underwent D-TACE combined with microwave ablation or D-TACE combined with microwave ablation followed by PD-1 inhibitor in the Oncology Department of the Affiliated Hospital of Youjiang Medical College for Nationalities from January 2017 to September 2022 were retrospectively collected and analyzed.After excluding contraindications to surgery,D-TACE combined with microwave ablation was performed.PD-1 treatment was performed according to the laboratory data and physical recovery after 1 week after surgery,with the informed consent of the patients and their families.The patients were divided into D-TACE+MWV+PD-1 group and D-TACE+MWV group according to the treatment regimen.The adverse reactions during treatment and follow-up were observed.The laboratory tests and imaging examinations(CT or MRI)before and after treatment were compared,complete response,partial response,progressive disease and stable disease were evaluated according to the modified Response Evaluation criteria in Solid tumors.The tumor response was evaluated,and the survival was recorded.Such as overall survival(OS),progression-free survival(PFS)and adverse events.The survival curve was drawn,and the univariate and multivariate prognostic factors of PFS and OS were analyzed by multivariate Cox proportional hazards regression model.The major adverse events were observed and the safety risk was evaluated.Results:A total of 87 patients were enrolled in this study,including 42 patients in the D-TACE+MWV+PD-1 group and 45 patients in the D-TACE+MWV group.There was no significant difference in baseline characteristics between the two groups(P >0.05).The ORR of D-TACE+MWA+ PD-1 group was 64.3%,and that of TACE+MWA group was 48.9%,and the difference was statistically significant(P = 0.011).The DCR of TACE+MWA+ PD-1group was 88.1%,which was higher than that of TACE+MWA group(80.0%),and the difference was statistically significant(P = 0.032).The median PFS of D-TACE+MWA+PD-1 group and D-TACE+MWA group were 17.7 months and 13.9 months,respectively,and the difference was statistically significant(P=0.018).The median OS of D-TACE+MWA+PD-1 group and D-TACE+MWA group were 30.5 months and 23.2 months,respectively,and the difference was statistically significant(P=0.015).In univariate and multivariate analysis,treatment methods and Child-Pugh classification were independent prognostic factors affecting survival(P < 0.05).No treatment-related grade 4 or 5 adverse events occurred in either group.The most common adverse complications in D-TACE+MWA +PD-1group and D-TACE+MWA group were new-onset ascites(14.3% vs.17.8%,P=0.658)and segmental bile duct dilatation(9.5% vs.6.7%,P= 0.924).Conclusion:(1)Compared with TACE+MWA alone,TACE+MWA sequential PD-1inhibitor has better anti-tumor effect,can prolong the survival time of Barcelona stage B primary liver cancer,and is safe and controllable.(2)Treatment method and Child-Pugh grade were independent risk factors affecting the overall survival of patients with stage B primary liver cancer in Barcelona.