| Objective: Partial hepatectomy is the main treatment for hepatocellular carcinoma(HCC)at present.However,the recurrence rate within 5 years after surgery is as high as more than 50%,which seriously reduces the survival rate of patients.Sorafenib(targeted anti-tumor drug)and PD-1 monoclonal antibody(immune checkpoint inhibitor)play a good role in the systemic treatment of hepatocellular carcinoma,but whether they can effectively prevent the recurrence of hepatocellular carcinoma with microvascular invasion after surgery is rarely reported.The aim of this study is to investigate the preliminary efficacy and safety of sorafenib or sorafenib combined with PD-1 monoclonal antibody in the prevention of postoperative recurrence of hepatocellular carcinoma patients with MVI by retrospective analysis of patients with hepatocellular carcinoma with microvascular invasion admitted to the Affiliated Hospital of Qingdao University and to provide reference for the prevention of postoperative recurrence in patients with hepatocellular carcinoma.Methods: A total of 120 patients with hepatocellular carcinoma and microvascular invasion who underwent radical resection in the Affiliated Hospital of Qingdao University from July 2014 to December 2020 were retrospectively analyzed.The patients were divided into control group and experimental group according to whether to use target-free therapy,with 60 cases in each group.The observation group was treated with sorafenib or sorafenib combined with pd-1 map,while the control group was treated with non-target immunotherapy,which was ather than targeted immunotherapy(such as anti-hepatitis B drug therapy,traditional Chinese medicine anti-tumor therapy,etc).The patients were followed up for 2 years.The baseline data of the two groups were compared.General data(age,gender,history of drinking,history of hepatitis B),clinicopathological data(nodular cirrhosis,MVI stage,number of satellite nodules,number of lesions,maximum diameter of tumor),perioperative indicators(intraoperative blood loss,time of hepatic portal occlusion,duration ofoperation),liver function indicators [gamma-glutamyltransferase(GGT),alanine aminotransferase(ALT)] were collected,aspartate aminotransferase(AST),total bilirubin(TB),albumin(ALB)],tumor markers [carcinoembryonic antigen(CEA),alpha-fetoprotein(AFP),carbohydrate antigen 199(CA199),carbohydrate antigen125(CA125)];All patients were followed up for at least 2 years.The clinical efficacy(recurrence rate of 6 months after operation,recurrence rate of 12 months after operation,recurrence rate of 24 months after operation,tumor-free survival time)and drug safety(postoperative medication time,incidence of postoperative adverse reactions)were compared between the two groups.Univariate analysis was used to screen the suspicious risk factors of postoperative recurrence of HCC,and binary Logistic regression analysis was used to determine the independent risk factors of postoperative recurrence of HCC.Results Among the 120 patients,there were 105 male patients and 15 female patients,accounting for 87.5% of male patients and 12.5% of female patients.The average age was 57.8 years,with a minimum age of 33 years and a maximum age of77 years.There were no significant differences in baseline data,age,gender,and liver function between the two groups(P>0.05).The recurrence rates of 120 patients at 6months,12 months and 2 years after operation were 26.67%(32/120),47.50%(57/120)and 65.83%(79/120),respectively.The recurrence rates of the control group were46.67%(28/60),76.67%(46/60)and 95.00%(57/60),and the recurrence rates of the observation group were 6.67%(4/60),18.33%(11/60)and 36.67%(22/60),respectively.The recurrence rates at 6 months,12 months and 2 years after operation were compared between the two groups(x2=26.144,P<0.001;x2 = 38.630,P<0.001;x2=42.828,P<0.001).The minimum tumor-free survival time of 120 patients was 1 month and the maximum was 54 months,and the average value was 15 months.The tumor-free survival time of the control group was(7.7±5.1)months,and that of the observation group was(22.5±10.8)months.(P>0.05).There was no significant difference in the incidence of adverse reactions and medication time between the two groups(P>0.05).Univariate analysis showed that drinking history,hepatitis B history,MVI stage,satellite nodule,number of lesions,maximum diameter of tumor,operation time,alpha-fetoprotein,CA125 and whether to use sorafenib or sorafenib combined with PD-1 monoclonal antibody were suspected risk factors for postoperative recurrence(x 2=3.923,P=0.048;x 2=3.310,P=0.068;x 2=5.913,P=0.025;x2=7.480,P<0.001;x2=5.662,P=0.017;x2=7.023,P=0.008;x2= 9.533,P=0.002;x2=3.028,P=0.079;x2=3.067,P=0.080,x2=45.384,P<0.001).Binary Logistic regression analysis showed that alpha-fetoprotein,sorafenib or sorafenib combined with PD-1 were independent risk factors for postoperative recurrence(RR=3.762,0.023,95% confidence interval 1.009-12.762,0.004-0.142,P<0.05).Log-Rank test was used to compare the tumor-free survival between the two groups,and the results showed that the tumor-free survival of the two groups was statistically significant(x2=71.850,P<0.001).Conclusions: Alpha-fetoprotein,MVI stage and not to use sorafenib or PD-1monoclonal antibody are independent risk factors for postoperative recurrence of hepatocellular carcinoma with microvascular invasion.Sorafenib or sorafenib combined with PD-1 monoclonal antibody can reduce the risk of recurrence and has clinical guiding significance. |
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