Clinical Efficacy And Effect Of CBATO On Liver Fibrosis In Middle And Advanced Hepatocellular Carcinoma

Objective:By comparing the clinical efficacy of CalliSpheres Beads(CB)loaded with arsenic trioxide(ATO)(CBATO)with conventional transcatheter arterial chemoembolization(cTACE)in patients with moderately advanced hepatocellular carcinoma(HCC),the safety and efficacy of CBATO were preliminarily evaluated,and the effects of the two treatment modalities on liver fibrosis were explored.Methods:Clinical data of 61 initially diagnosed HCC patients with single or sum of 2-3 tumor diameters≥ 5 cm were collected from December 2018 to December 2019 in our hospital.34 patients were treated with CBATO(CBATO group)and 27 were treated with cTACE(cTACE group).Preoperative serological results and imaging data were collected for all patients.The FIB-4 and APRI index were calculated according to the relevant biochemical results in two models for the noninvasive diagnosis of liver fibrosis,and liver stiffness value measurement(LSM)was performed using real-time shear wave elastography(SWE)technique.Liver function,tumor control rate,tumor progression free survival,and the number of TACE treatments received within 6 months in the two groups of patients before and after treatment were recorded at follow-up to evaluate the safety and efficacy of cbato.Four items of liver fibers:HA,LN,PC-Ⅲ,Ⅳ-Cand FIB-4 index,APRI index,and LSM value changes were recorded before the first operation and 6 months after operation to evaluate the effects of the two treatment modalities on liver fibrosis.Statistical analysis of data between two groups was performed using SPSS version 21.0,and P<0.05 was considered statistically significant.Results:1.The patients in CBATO group and cTACE group successfully completed TACE treatment,and there was no significant difference in the hepatic function indexes between the two groups before operation,7 days and 1 month after operation(P>0.05).Liver function measures were significantly higher in both groups 7 days after surgery compared with before surgery,and the values were statistically significant(P<0.05).Liver function measures decreased in both groups 1 month after surgery,with no significant difference compared with before surgery(P>0.05).2.There were no major postoperative complications in either group,the incidence of postoperative fever,nausea and vomiting was lower in the CBATO group compared with the cTACE group(P<0.05),while the incidence of adverse effects such as pain and thoracic ascites was not significantly different between the two groups(P>0.05).3.The objective response rate was 64.71%,37.03%,and the disease control rate was 82.35%,55.56%in the CBATO and cTACE groups,respectively,at 6 months after the first operation,and the objective response rate and disease control rate were significantly different between the two groups(P<0.05).The number of TACE sessions over a 6-month period was compared between the two groups(P<0.05).4.The progression free survival of patients treated with CBATO versus cTACE was plotted using the Kaplan-Meier method and compared using the log-rank test,and significant differences(P<0.05)were observed between the two survival curves.5.There were no significant differences in the four indicators of liver fibrosis,PC-Ⅲ,HA,LN and Ⅳ-C,between the two groups before operation(P>0.05).Four items of liver fiber were significantly higher in both groups at 6 months after surgery compared with before surgery(P<0.05),and when the four items of liver fiber were compared between the two groups,the increase was more obvious in the cTACE group,with a significant difference(P<0.05).6.The FIB-4 index,APRI index,and LSM values were compared between the two groups preoperatively,and there were no significant differences(P>0.05).The FIB-4 index,APRI index,and LSM values of the two groups at 6 months after the first operation were increased compared with those of the patients before operation(P<0.05).When the three indexes were compared between the two groups,the increase in the cTACE group was even more significant and statistically significant(P<0.05).Conclusions:1.Compared with cTACE in middle and advanced HCC treated with CBATO,there were no significant differences in liver function changes;the recent efficacy,incidence of adverse effects and progression free survival of CBATO group were better than cTACE group;CBATO group received TACE treatment significantly less than cTACE group within 6 months after first operation;CBATO is a safe and effective treatment.2.The liver fibrosis of patients after operation was aggravated between CBATO group and cTACE group compared with that before operation,but the aggravation of liver fibrosis in CBATO group was less than that in cTACE group.