Comparison Of Efficacy Of Lobaplatin And Doxorubicin Hydrochloride Liposome In Preventing Tumor Recurrence After Radical Resection Of Hepatocellular Carcinoma

Background:Primary liver cancer is the fifth most common malignant tumor in the world,accounting for the third cause of cancer death,only after gastric cancer and esophageal cancer.More than half a million people worldwide develop liver cancer each year,more than half of them in China.Primary liver cancer is divided into hepatocellular carcinoma,cholangiocarcinoma,mixed type,in which hepatocellular carcinoma accounts for the vast majority,about 95%.Surgical resection is the primary treatment for primary liver cancer,but the 5-year survival rate is only about 50%,and the 5-year recurrence rate can reach 60%～70%.For patients with poor prognosis,identifying the best adjuvant treatment is the key to reduce postoperative recurrence and metastasis rates and improve postoperative survival.Trans vascular interventional therapy for liver cancer emerged in the 1970s,among which hepatic arterial chemoembolization(TACE)is the most classic treatment.At that time,except for surgical resection,there was no other effective means for the treatment of liver cancer.However,the emergence of transvascular interventional therapy represented by TACE opened up a new way for the clinical treatment of liver cancer.Therefore,it developed rapidly in a short period of time and was widely used in clinical practice.In order to reduce postoperative recurrence rate and prolong the survival time,preventive is effective with conventional interventions,there is a lot of literature is pointed out that hepatocellular carcinoma after radical resection preventive compared with conventional no preventive conventional TACE can effectively improve the overall survival and disease-free survival,especially in patients with liver cancer and the existence of MVI,has an effect of comprehensive treatment of 293 cases of primary liver cancer recurrence analysis pointed out that in the median survival period is greater than the conservative groups.At present,the commonly used chemotherapeutic drugs for TACE for liver cancer include doxorubicin(or epirubicin),mitomycin C,cisplatin,as well as X such as arsenic trioxide,5-fluorouracil(5-Fu),ratitrexed,hydroxythectothecin(HCPT)for injection.TACE embolization is the key.So far,whether chemotherapy drugs are necessary is still controversial.There is no consensus on which chemotherapy drugs are more effective in preventing recurrence of HCC after surgery,and more studies in this field are needed to solve this problem.Objective:To find relatively sensitive chemotherapy drugs,what is expected to further reduce the recurrence rate and prolong the survival time of patients with HCC after radical resection,which can guide the selection of local hepatic artery perfusion chemotherapy drugs in clinical practice.Independent risk factors for postoperative recurrence were also studied.Methods:Retrospective analysis was made of the clinical data of patients with hepatocellular carcinoma who underwent radical resection of liver cancer and were pathologically confirmed to be hepatocellular carcinoma from September 2010 toSeptember 2019 in the Second Department of Hepatobiliary and Biliary Surgery of Zhujiang Hospital of Southern Medical University,who returned to the hospital for reexamination every month after surgery for at least six consecutive months or until recurrence.The reexamination items included liver function,hepatitis B index,AFP and coagulation.The examinations included upper abdominal and chest enhanced CT,upper abdominal MRI and PET-CT when necessary.A total of 201 cases were eventually included.According to the chemotherapy drugs used for postoperative TACE(loplatin 10mg,doxubicin hydrochloride 20mg),they were divided into:loplatin group(n=54),doxubicin hydrochloride liposome(n=118),and simple embolization group(n=29).Finally,the recurrence time of patients after surgery was calculated.The recurrence time was mainly based on imaging findings,and AFP value could be referred to.Choose different time node statistics recurrence rate and estimate the median time to relapse,the median surial,will collect the clinical data of square test with SPSS line 21 RXC card calculation of three groups of data of gender,age,hospital liver function grading,Barcelona for the first time when the operation stage,whether to have second liver,tumor diameter and number of tumors,tumor location,capillary tumor emboli,preoperative AFP,are there differences between the degree of tumor differentiation,calculate liver cancer effect a radical cure postoperative recurrence in January,march,June,if there is a difference between groups.Median estimates of tumor-free survival and survival analysis with tumor recurrence as the endpoint(Kaplan-Meier survival curve and Cox risk regression analysis of relapse related factors).Results:There was no significant difference in the recurrence rates of lobaplatin group,doxorubicin hydrochloride liposomal group and simple embolization group 3 months after operation(11.1%,21.2%,17.2%,P>0.05),6 months after operation(15.4%,31.6%,37.9%,P<0.05),12 months after operation:24.8%,50.0%,52.2%(P=0.011);Median tumor-free survival could not be estimated;The independent risk factor for recurrence was the maximum tumor diameter<5cm(HR=0.391;P=0.002;95%CI[0.214,0.717])and early Barcelona staging(HR=0.333;P=0.001;95%CI[0.178,0.622]),no microvascular tumor thrombus(HR=0.460;P=0.008;95%CI[0.258,0.819]);There were no serious adverse reactions to chemotherapy,mainly including abdominal pain(94.03%),fever(85.07%),anaphylaxis(5.47%),significantly elevated blood pressure(19.90%),vomiting(10.45%)and thrombocytopenia(8.46%).Conclusion:1.The curative effect of lobaplatin is significantly better than doxorubicin liposome 6 months after radical resection,which can significantly prevent postoperative recurrence,consolidate the tumor-free state,and improve the curative effect of radical resection of hepatocellular carcinoma.Appropriate amount of lipiodol plays an auxiliary role in hepatic deposition.2.Maximum tumor diameter<5cm,early Barcelona stage and no microvascular thrombus were independent risk factors for recurrence,while gender,age at surgery,whether the tumor was single,liver function score at admission,tumor location,hepatitis B,degree of differentiation,and preoperative primary fetal egg<400 were not.3.Adjuvant hepatic artery embolization chemotherapy is safe and effective,and can be tolerated by a wide range of people.doxorubicin hydrochloride liposomes was more better.