Comparison Of Efficacy And Safety Of HAIC And TACE In Patients With Advanced HCC Under MDT In Tibet

Objective:To compare the efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)and transcatheter arterial chemoembolization(TACE)in the treatment of advanced hepatocellular carcinoma(HCC)at MDT.HAIC group and TACE group combined with anti-PD-1 immunization(Sindilizumab)Therapy and TKIS(Lenvatinib)treatment of CNLCⅡb～Ⅲb patients with advanced HCC,by comparing the clinical and pathological characteristics,progression-free survival To provide reference for the standardized diagnosis and treatment of triple mode data of liver cancer in Tibet,improve the quality of life of patients and prolong their survival time.Methods:A total of 76 patients with CNLC stage Ⅱb～Ⅲb who met the inclusion criteria from January 2018 to December 2022 were enrolled,including 34 patients in HAIC combined group and 42 patients in TACE combined group.After the MDT,both groups were treated with TKIS and anti-PD-1 immunotherapy.The treatment effect was evaluated by abdominal enhanced CT or MRI,and the efficacy evaluation period was every 4-8 weeks.The efficacy evaluation was finally performed according to the response evaluation criteria in solid tumors version 1.1(RECIST 1.1).Through followup to understand the survival of patients in two groups,draw the survival curve,analysis of influencing factors,observe the two groups of toxic and side effects,to evaluate the two treatment programs which is better.Results :1.The median overall survival(m OS)was 22.5 months in HAIC group and 11.0months in TACE group(HR=0.3322,95% CI:0.1903～0.5798,P=0.0001),the m PFS(median progression-free survival)of the two groups was 13.0 months and 5.0 months,respectively(HR=0.3160,95% CI:0.1406～0.6861,P=0.0038),the difference was statistically significant(P <0.05).II 2.The proportions of PR,SD and PD in the HAIC combination group were:2.9%,70.6% and 26.5%;The proportions of PR,SD and PD in the TACE combined group were as follows:2.4%,40.5%,and 57.1%,DCR(73.5%vs 42.9%,P=0.007),with a significant difference between the two groups(P<0.05).3.Subgroup analysis of influencing factors of PFS in the two groups:In the PFS subgroup analysis table of HAIC combination group and TACE combination group,it can be seen that ALBI grade3,tumor diameter ≤7cm and NLR≤3(neutrophil/lymphocyte)play a crucial role in the progression-free survival of patients,and the difference of these influencing factors in subgroups is statistically significant(P<0.05).4.Subgroup analysis of influencing factors of OS in the two groups:In the OS subgroup analysis table of HAIC combined group and TACE combined group,it can be seen that ALBGrade 2-3,tumor diameter ≤7cm,NLR≤3(neutrophil/lymphocyte)play a crucial role in the overall survival of patients.The most common grade 3/4 treatment-related adverse events between the two groups were abdominal pain(9[26.5%] VS 19[45.2%])and liver dysfunction(8[23.5%] VS 35[83.3%]),with no significant difference between the two groups.However,all AES patients were tolerated and no treatment-related death occurred.Conclusion :1.HAIC combined with TACE has stronger anti-tumor activity than TACE combined with TACE,which can significantly improve the short-term efficacy of SD,DCR and PFS,OS in patients with CNLCIIb-IIIb liver cancer in Tibet.2.In the PFS subgroup analysis table of HAIC combination group and TACE combination group,it can be seen that ALBIgrade3,tumor diameter ≤7cm and NLR≤3(neutral granulocyte/lymphocyte)play a crucial role in the progression-free survival of patients;In the OS subgroup analysis tables of the combined HAIC arm and the combined TACE arm,it can be seen that ALBI grade 2-3,tumor diameter ≤7cm,and NLR≤3(neutrophils/lymphocytes)play a crucial role in the overall survival of patients.3.HAIC triple regimen is a safe and effective regimen for the treatment of unresectable HCC.This combination therapy is better than TACE-based combination therapy in terms of efficacy,survival and safety.