The Research Of MRECIST Combined With AFP In The Efficacy Evaluation Of Targeted Therapy For Middle Or Advanced HCC

Objective:The clinical cases of patients with middle or advanced HCC who received targeted drug therapy were retrospectively analyzed,and the survival benefit indexes of patients in mRECIST(modified response evaluation criteria in solid tumors)combined with AFP(alpha fetoprotein)in evaluating the efficacy of targeted therapy were compared.To explore the real survival benefits of patients with AFP<200 ng/ml in SD(stable disease)evaluated by mRECIST,and to supplement and improve mRECIST.Methods:The clinical data of patients with middle or advanced"HCC"diagnosed in the affiliated Hospital of Guilin Medical College in the past 3 years(July 2018 to July 2021)were collected and screened by mRECIST,admission criteria and exclusion criteria,and were divided into two groups according to AFP≥200ng/ml and AFP<200ng/ml.SPSS statistical software was used to analyze the survival,and life table method was used to analyze survival.Kaplan-Meier survival curve was used to analyze the difference of survival time among different groups.The difference was analyzed by chi-square test and independent sample t-test of paired data.Univariate analysis showed that there was significant difference by Log-rank test.The indexes of survival benefit were compared between the two groups according to the mRECIST.Results:51 cases met the inclusion criteria,including 10 cases of CR(complete response),30 cases of PR(partial response),9 cases of SD and 2cases of PD(progressive disease).Through the life table method of the two groups,it is calculated that:(1)The median PFS(progression-free survival)of the population sample equals 7months[95%CI 5.395 to 8.695].(2)The median PFS of PR in AFP<200 ng/ml group equals 7 months[95%CI 4.090-9.910],the median PFS of PR in AFP≥200 ng/ml group equals 8 months[95%CI 4.669-11.331],and the median PFS of total PR in both groups equals 8 months[95%CI 6.222-9.778].(3)The median PFS of SD in AFP<200 ng/ml group equals 8 months[95%CI 5.006-10.994],the median PFS of SD in AFP≥200 ng/ml group equals 3 months[95%CI 2.123-3.877],and the median PFS of total SD in both groups equals 6months[95%CI 0.000-14.765].Through the independence t test,Log-rank test and survival curve comparison between the two groups,the results were as follows:(1)The PFS survival curves of the two groups of PR intersected and accompanied,and the results of PFS univariate analysis(AFP)Log-rank test of the two groups of PR:χ~2=0.198,P=0.657>0.05.(2)The PFS survival curve of SD in AFP<200ng/ml group was higher than that in AFP≥200 ng/ml group,and the result of PFS univariate analysis(AFP)Log-rank test of SD in both groups:χ~2=5.067,P=0.024<0.05.(3)The statistics of variance homogeneity test of total PR and SD in AFP<200 ng/ml Group:F=2.881,P=0.099<0.10.Independent sample t-test:t=﹣0.913,ν=3.263,P=0.423>0.05.The 95%confidence interval of the PFS mean difference(-4.047)between total PR and SD in AFP<200 ng/ml group equals[-17.609,9.476].The survival curves of total PR and SD in AFP<200 ng/ml group intersected and accompanied.Conclusion:For the middle or advanced HCC patients whose mRECIST efficacy evaluation equals SD,combined with AFP can more accurately evaluate the survival benefits of targeted therapy.