The Efficacy And Prognostic Factors Of TACE Combined With Apatinib In The Treatment Of Stage BCLC-C Hepatocellular Carcinomas

Research purposes:Hepatocellular carcinoma（HCC）is one of the most common malignant tumors in the world.The incidence of HCC is hidden,and it is often too late for patients to see a doctor.In China,local treatment based on transcatheter arterial chemoembolization（TACE）is a very important treatment for patients with the advanced liver cancer.TACE can inhibit tumor growth,block the blood supply of tumor and induce ischemia and hypoxia of tumor by injecting chemotherapeutic drugs and embolic agents into the feeding artery of hepatocellular carcinoma.However,studies have shown that vascular endothelial growth factor（VEGF-α）in residual HCC tissue after TACE is significantly increased,thus promoting residual tumor angiogenesis.Therefore,it is of great significance to carry out anti-angiogenic therapy in patients treated with TACE.Apatinib is a small molecule targeting drug with independent intellectual property rights in China.It can selectively act on the ATP binding site of VEGF receptor in tumor cells,inhibit tumor angiogenesis after TACE treatment,and improve the local efficacy and long-term survival rate of patients with HCC.To explore the efficacy and prognostic factors of transarterial chemoembolization of（TACE）combined with apatinib in the treatment of stage BCLC-C HCC.Methods:Clinical data of 146 patients with stage BCLC-C HCCs in our hospital were collected and analyzed retrospectively,of which 76 cases were treated with TACE combined with apatinib（TACE-apatinib）and 70 cases were treated with TACE alone.The baseline data of the two groups included sex,age,ECOG,AFP value before treatment,portal vein tumor thrombus（PVTT）,tumor size,tumor number,extrahepatic metastasis,hepatitis history,Child-Pugh score and so on.After treatment,the patients in both groups were followed up.According to The Modified Response Evaluation Criteria in Solid Tumors（m RECIST）,the local curative effect was evaluated。Adverse events were evaluated according to The Common Terminology Criteria for Adverse Events（CTCAE）version4.0,the general terminology of adverse events.The local curative effect,survival time and adverse events of the two groups were compared,and the factors affecting the prognosis were analyzed.Results:There was no significant difference between the two groups of clinical medical materials in age,sex,ECOG,AFP value before treatment,portal vein tumor thrombus,tumor size,tumor number,extrahepatic metastasis,hepatitis history,Child-Pugh score.The objective remission rate（ORR）and disease control rate（DCR）of the TACE-apatinib group were higher than those of the TACE-alone group.The median time to progression（TTP）and overall survival（OS）in the TACE-apatinib group were longer than those of the TACE-alone group（TTP:5.5 months vs 3.7 months,respectively,P=0.02;OS:10.0months vs 6.2 months,respectively,P=0.01）.Univariate and multivariate Cox regression analysis indicated that tumor size,Child-Pugh grade and PVTT may be factors affecting the prognosis of patients.Subgroup analysis revealed that TACE-apatinib therapy had a higher OS for patients with Child–Pugh class A,tumor size <10cm or≥10cm,with PVTT or without PVTT（P<0.05）.The adverse events of hand-foot syndrome,hypertension,and oral ulcer was significantly increased in the combination therapy group compared with the control group（P < 0.05）.Conclusion:TACE-apatinib is an effective and safe method in the treatment of stage BCLC-C HCC.TACE-apatinib is more effective than TACE alone and can improve the ORR and DCR of patients.Compared with TACE-alone,TACE-apatinib can improve the prognosis of patients and significantly prolong the time to progression and overall survival.Tumor size,Child-Pugh grade and PVTT are independent risk factors affecting the prognosis of patients.