Comparison Of The Efficacy Of TACE Therapy With TACE Combined With Targeted Drugs In Patients With Hepatocellular Carcinoma Based On MRECIST Criteria

Objective To compare efficacy of different treatments for patients with hepatocellular carcinoma(HCC)assessed based on the mRECIST criteria and to observe the overall survival(OS)and progression-free survival(PFS)between different groups.Methods This study retrospectively included 69 patients with hepatocellular carcinoma from the Affiliated Zhongda Hospital of Southeast University.Patients were divided into TACE treatment alone group and TACE plus TKI group according to their different treatment modalities,including 38 cases in the TACE alone group and 31 cases in the TACE plus TKI group.Patients’ tumor response was evaluated by CT/MR enhanced imaging before and three months after the first treatment.The mRECIST criteria were used to measure the enhanced fraction of patients’ target lesions before and after treatment to assess the tumor response,and to calculate the disease control rate(DCR)and objective response rate(ORR)of patients with hepatocellular carcinoma,and to compare the difference in efficacy between different groups using chi-square test.The clinical data of patients were collected and followed up for at least 6 months,and the Kaplan-Meier survival curve was used to compare the overall survival(OS)and progression-free survival(PFS)of patients between the two groups.Univariate and multivariate Cox proportional risk analyses were performed to determine the factors influencing OS.The area under the ROC curve was used to assess the predictive efficacy of mRECIST efficacy outcomes versus the BCLC staging system for early patient progression.Results.The DCR(CR+PR+SD)was 84.5% and ORR(CR+PR)was 34.2% in the TACE alone group,while the DCR was 93.5% and ORR was 67.8% in the TACE plus TKI treatment group,and there was a statistically significant difference in short-term efficacy between the two groups(χ2=7.678,p=0.008).Kaplan-Meier survival curve analysis showed that the TACE-TKI group median OS(37.0±5.6 months)was significantly longer than the TACE alone group(15.0±5.7 months),and the difference was statistically significant(p=0.012),but the difference in PFS between the two groups was not statistically significant(p=0.203).Univariate and multifactorial analyses of patients showed that patient age,presence or absence of envelope,AST level,and patient’s treatment modality were independent influences on overall patient survival.In the ROC curves for mRECIST efficacy outcomes and BCLC staging to predict whether patients progressed early,efficacy outcomes combined with BCLC had good predictive efficacy for all patients and across treatment subgroups(AUC: 0.664;0.695;0.733).Conclusion The evaluation results based on the mRECIST criteria showed a significant difference in tumor response between the TACE alone group and the TACE combined with TKI group,in which the OS in the TACE plus TKI group was significantly longer than that in the TACE alone group,while there was no significant difference in PFS between the two.Patient age,presence or absence of envelope,AST level and patient’s treatment modality were independent influencing factors for patient OS.The efficacy of the mRECIST diagnosis combined with the BCLC staging system can predict to some extent whether patients have the possibility of early progression.