Analysis Of Efficacy And Safety Of Different TACE Combined Sorafenib Treatment Models In The Treatment Of Advanced Hepatocellular Carcinoma

ObjectiveTo analyze and compare the efficacy and safety of different TACE combined sorafenib treatment models in the treatment of unresectable advanced hepatocellular carcinoma and,explore a more suitable treatment for unresectable advanced hepatocellular carcinoma.Methods276 patients who were diagnosed as unresectable advanced hepatocellular carcinoma in the First Affliated Hospital of Zhengzhou University from January 2017 to January 2019 were brought into research.On the basis of the treatment plans,they were split into three groups,including TACE only group(control group)162 cases,the "continuous treatment model" group.(observation group A)58 cases and the"interrupted treatment model" group(observation group B)56 cases.Compare the efficacy and safety of three treatment regimens by analyzing the preoperative and postoperative hematological indicators,the incidence of postoperative adverse reactions and follow-up indicators.Results1.For unresectable advanced hepatocellular carcinoma,the median overall survival(P both<0.001),median progression free survival(P both<0.001),objective response rate(P both<0.001)and disease control rate(P both<0.001)of TACE combined sorafenib groups(the "continuous treatment model" group and the"interrupted treatment model" group)were better than that of TACE only group,the differences were statistically significant.2.For unresectable advanced hepatocellular carcinoma,the incidence rates of dermatotoxic reactions like hand-foot-skin reaction(P both<0.001),rash(P<0.001 and P=0.002),alopecia(P=0.002 and 0.009)and diarrhea(P both<0.001),secondary hypertension(P both<0.001)of all grades of TACE combined sorafenib groups(the"continuous treatment model" group and the "interrupted treatment model" group)were higher than that of TACE only group,the differences were statistically significant.But the vast majority of incidence rates were grade Ⅰ to Ⅱ and the adverse reactions could be eased by symptomatic treatments,reducing or discontinuing sorafenib.The incidence rate of hand-foot-skin reaction of grade Ⅲ toⅣ of.TACE combined sorafenib groups(the "continuous treatment model" group and the "interrupted treatment model" group)were higher than that of TACE only group,the differences were statistically significant(P<0.001 and P=0.001).The differences in.incidence rates of bone marrow suppression,liver function damage,renal function damage,nausea and vomiting,stomachache,fatigue,fever and gastrointestinal bleeding among TACE combined sorafenib groups(the "continuous treatment model"group and the "interrupted treatment model" group)and TACE only group had no statistical significance(P all>0.05).3.The median overall survival of the "continuous treatment model" group was better than that of the "interrupted treatment model" group and the difference between the two groups had statistical significance(P=0.016).There was no significant difference in the median progression free survival(P=0.038),ORR(P=0.351)and DCR(P=0.284)between the two groups.4.The incidence rates including hand-foot-skin reaction(P=0.015),rash(P=0.015)and secondary hypertension(P=0.012)of the "continuous treatment model" group were higher than that of the "interrupted treatment model" group and the differences were statistically significant.But the differences were only existed in the all grades and not in the grade Ⅲ to Ⅳ.All the adverse reactions could be eased by symptomatic treatments,reducing or discontinuing sorafenib.There was no significant difference in the bone marrow suppression,liver function damage,renal function damage,alopecia,nausea and vomiting,stomachache,fatigue,fever and gastrointestinal bleeding between the two groups(P all>0.05).Conclusion1.TACE combined sorafenib is more effective in treating unresectable advanced hepatocellular carcinoma than TACE alone and has good safety.2.The "continuous treatment model" is more effective in treating unresectable advanced hepatocellular carcinoma than the "interrupted treatment model" and does not increase the incidence of serious adverse reactions.The "continuous treatment model" is an ideal choice for patients with unresectable advanced hepatocellular carcinoma.