| Background and Aim:Hepatocellular carcinoma(HCC)is a major disease that seriously threatens the worldwide public health.The global morbidity rate ranks fourth among all malignant tumors,and the mortality rate ranks sixth[1,2].China is an area with a high incidence of Hepatitis B Virus(HBV)infection.There are about 80 million chronic HBV infections in the country,about 20 million chronic active hepatitis patients,and nearly 7 million patients with liver cirrhosis.In China,there are about 370 thousand new liver cancers each year,and most of them are caused by HBV infection,other causes are chronic hepatitis C virus infection,alcoholic liver disease,non-alcoholic steatohepatitis and so on.In Europe and America,there are more liver cancers caused by chronic hepatitis C virus infection and alcoholic liver disease.The current overall prognosis of liver cancer is still very poor[3].The five-year survival rate of liver cancer in the United States is only 18%,while the clinical registration survey of primary liver cancer(CLCS)in China shows that the five-year survival rate is only 12.1%.In the past ten years,breakthroughs have been made in HCC research,such as early screening and diagnosis technologies,as well as the treatment of liver cancer.In terms of diagnosis,the development and application of new biological markers and liquid biopsy technology is expected to improve the level of early diagnosis of liver cancer.In terms of treatment,the launch of new molecularly targeted drugs,immune checkpoint blockers and other new drugs have significantly improved the survival rate of liver cancer.In addition,the management of HCC patients,especially the screening and multidisciplinary collaborative diagnosis and treatment of high-risk groups,has increased the rate of early diagnosis of liver cancer and improved the overall treatment effect.However,the early diagnosis rate and treatment effect of liver cancer in current clinical practice are still unsatisfactory,and the overall survival rate is low.Therefore,through the real-world study cohort,in-depth study of the effects of various treatment options on the efficacy and safety of HCC will help guide clinical practice,improve the efficacy of liver cancer and improve the prognosis of patients.Since 2012,based on the long-term follow-up cohort of patients with chronic hepatitis B,our center has established a retrospective,prospective,and observational HCC real-world study cohort.The clinical data of the patients is sorted and analyzed,which is expected to be useful for HCC treatment and management.This study consists of two parts:Part 1 Aim:to explore the effect of entecavir antiviral therapy on the prognosis of HBV-related HCC after transcatheter arterial chemoembolization(TACE).Method:170 cases of HCC patients who received TACE treatment at the Liver Tumor Center of Nanfang Hospital from January 2011 to March 2018,including 114 cases in the entecavir treatment group and 56 cases in the control group(not receiving antiviral treatment).Record baseline demographic data,virological indicators,liver function indicators,AFP levels,Child-Pugh classification and BCLC staging before treatment,as well as disease progression at 4 to 8 weeks after treatment and at the end of follow-up,and observe the short-term and long-term clinical results of patients Benefit(overall survival).The t test or Wilcoxon signed rank test was used to compare the measurement data between the two groups;the chi-square test was used to compare the count data between the two groups.Single factor and logistic regression multivariate analysis of clinical related indicators before treatment were carried out in order to find the risk factors related to HBV reactivation.The Kaplan-Meier method was used to analyze the survival curve of overall survival,and the Log-rank test was used to test the difference between the survival curves.Result:The incidence of hepatitis B reactivation in the entecavir treatment group was not significantly different from that in the control group(18.4 vs 28.5%,x 2=2.272,p=0.132).The 1,3,and 5-year survival rates of the entecavir treatment group were 56.2%,30.3%,and 13.2%,respectively,and the 1,3,and 5-year survival rates of the control group were 60.6%,27.2%,and 16.3%,respectively.There was no significant difference in overall survival between the two groups(x 2=0.049,p=0.755).Conclusion:Entecavir antiviral therapy can reduce the incidence of HBV reactivation after TACE in patients with HBV-related HCC,and is expected to reduce the hepatotoxic side effects associated with TACE therapyPart 2:Aim:to evaluate the clinical efficacy and safety of second-line treatment carrelizumab combined with apatinib for unresectable HCC.Method:Include 94 patients with advanced HCC who received carrelizumab combined with apatinib as second-line treatment.Record the patient’s blood routine,blood biochemistry,tumor staging,tumor imaging characteristics,and previous treatment strategies and other clinical data before treatment,follow-up the patient’s imaging review results,and adverse reactions during treatment until the end of the follow-up or loss Visit or death.The Kaplan-Meier method was used to analyze the clinical efficacy of patients.Results:As of the last follow-up,a total of 15 patients were lost to follow-up,31 died,and 48 survived.The overall objective response rate(ORR)was 31.9%;the overall disease control rate(Disease control rate,DCR)was 71.3%.The median progression-free survival(PFS)was 6.6 months;the median progression-free time(TTP)had not yet been obtained;the 1-year cumulative survival(OS)was 62.3%.Adverse events above grade 3 mainly included thrombocytopenia(7.4%),abdominal pain(4.3%),hepatitis activity(4.3%),leukopenia(4.3%),diarrhea(3.2%),hand-foot syndrome(3.2%);adverse reactions After symptomatic treatment,they are effectively controlled.Conclusion:Carrelizumab combined with apatinib can effectively prolong the survival of patients with advanced HCC,and it is well tolerated. |
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