| Objective: intervention,systematic therapy and surgical resection of hepatocellular carcinoma have been available for many years,but there are relatively few reports of large-scale clinical studies reported from western China.The author aims to collect the case information of patients with hepatocellular carcinoma in Sichuan Provincial people’s Hospital in recent 5 years and summarize the treatment experience.Methods: Case information of hepatocellular carcinoma patients who underwent surgical resection(Surgical treatment,ST),surgical resection combined with postoperative auxiliary TACE(Postoperative adjuvant transarterial chemoembolization,PA-TACE),TACE(Transcatheter arterial chemoembolization,TACE),TACE combined with PD-1 inhibitor or TKI(TACE combined with PD-1 or TKI,TACE-P/T),TACE combined with PD-1 inhibitor and TKI(TACE-P-T)and HAIC combined with PD-1inhibitor and TKI(HAIC-P-T)in the hepatobiliary surgery department of Sichuan Provincial People’s Hospital between January 2017 and January 2022 were collected.All patients included in this study were divided into three subgroups: BCLC A stage,B stage and C stage according to the BCLC stage of liver cancer.The primary end point was overall survival time(OS)and the secondary end point was progression-free survival time(PFS).Results: A total of 318 patients with hepatocellular carcinoma were included in the study.In BCLC A,B and C groups,the median progression-free survival(m PFS)was 15months(95%CI:9.7-20.2),7 months(95%CI:0.2-13.8),and 2 months(95%CI:0.0-5.6)and the median overall survival time(m OS)of patients treated with ST(n=58)was 40 months(95%CI:20.8-59.3),25 months(95%CI:12.8-37.2),13 months(95%CI:0.0-39.1).The m PFS of patients treated with PA-TACE(n=65)was 17 months(95%CI:15.3-18.7),17months(95%CI:11.7-22.3)and 8 months(95%CI:7.4-8.6),the m OS was 33 months(95%CI:30.9-35.1),28 months(95%CI:18.9-37.1),19 months(95%CI:17.1-21.0).The m PFS of patients treated with TACE(n=111)was 1 month(95%CI:1.0-1.0),15 months(95%CI:10.9-19.1)and 7 months(95%CI:2.6-11.4),the m OS was 28 months(95%CI:17.4-38.6),20 months(95%CI:17.6-22.4)and 13 months(95%CI:5,3-20.7).The m PFS of patients treated with TACE-P/T(n=41)was 1 month(95%CI:1.0-1.0),15months(95%CI:10.9-19.1)and 7 months(95%CI:2.6-11.4),the m OS was 56 months(95%CI:22.0-91.4),23 months(95%CI:12.8-28.2),17 months(95%CI:11.4-22.6).The m PFS of patients treated with TACE-P-T(n=7)was 11 months(95%CI:11.0-34.0),1month(95%CI:1.0-1.0),2 months(95%CI:0.0-5.0),the m OS was 18 months(95%CI:18.0-18.0),7 months(95%CI:6.0-9.0),3 months(95%CI:0.0-13.5).In BCLC B and C groups,the m PFS of patients treated with HAIC-P-T(n=36)was 5 months(95%CI:0.0-7.0),5 months(95%CI:3.0-7.0),the m OS was 8 months(95%CI:7.0-21.0),11 months(95%CI:9.4-12.6),respectively.Univariate analysis showed that tumor diameter was negatively correlated with both PFS(r=-0.244,P<0.01)and OS(r=-0.331,P<0.01),while tumor number was negatively correlated with both PFS(r=-0.185,P<0.01)and OS(r=-0.190,P<0.01).The increase in the number of tumors increased the risk of death of patients,which was statistically significant(OR=1.097,95%CI:1.041-1.157,P=0.001).The increase of tumor diameter increased the risk of death(OR=1.101,95%CI:1.069-1.134,P < 0.001).Conclusion: Radical resection is still the first choice for patients with BCLC A and B stage hepatocellular carcinoma.For patients with BCLC B and C stage hepatocellular carcinoma,TACE combined with targeted or immunotherapy can prolong the survival time compared with TACE alone.Postoperative auxiliary TACE could not significantly prolong PFS and OS in patients with BCLC A stage,while it can significantly prolong PFS in patients with BCLC B stage.An increase in tumor number and diameter increases the risk of death. |
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