| BackgroundPrimary hepatocellular cancer is one of the most common solid tumor worldwide. a risen incidence has been observed recently also in developed countries.Its incidence is the highest in the Third World. however, Becauce of the features of the disease, majority of HCC patients are diagnosed in advanced stages, and treatment possibilities are limited for such patient population. Recently, novel treatment have emerged, including the use of molecular targeted agents, blockers of signaling pathways involved in hepatocarci- nogenesis. Sorafenib is an oral multikinase-inhibitor which is the first systemic agent to demonstrate survival benefit in advanced hepatocellular cancer. SHARP and Oriental research have fully proved that sorafenib can extend the survival of the patients with advanced hepatocellular carcinoma clearly. In theory, it also can improve the clinical efficacy combinating with interventional therapy. But the related domestic reports is limited. we collected 70 cases of hepatocellular cancer and respectively treated with interventional mono-therapy and sorafenib combination with interventional therapy in this study to Comparative Analysis and observe the efficacy and side effects of transarterial chemoembolization (TACE) combined with sorafenib for advanced hepatocellular carcinoma (HCC).METHODS:We studied a cohort of70 patients with hepatocellular cancer, diagnosed between January 2007 and August 2010 at China-Japan Union Hospital of Jilin University. All of the patients meet the standard and they divided into two groups ,43 patients was treated with interventional mono-therapy and 27 patients was treated with sorafenib combination with interventional therapy. We used SPSS 17.0 statistical software package to sort and analyze the data of 70 cases of hepatocellular cancer patients and analysis the clinical efficacy, Disease control rate(DCR),time to progression(TTP) and toxicity. Response to Combination group was evaluated according to the Response Evaluation Criteria In Solid Tumors (RECIST).Adverse events were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events,version 3.0 (NCI CTC 3.0) criteria.. we quantified these and usedχ~2 to test the count data of clinical indicators according to SPSS17.0 package and processing requirements,, taking P <0.05 as statistical significant and P <0.01 as conspicuous significant statistical. We used Log-Rank test to compare the survival rate of patients with different treatment.Result7 achieved a complete response(CR) in all patients,36 achieved a partial response (PR),24 had stable disease (SD) and 3 had progressive disease. The overall remission rate (CR+PR) was 61.4%(41/70),the disease control rate (CR+PR+SD) was 95.7%(67/70). The overall follow-up time was 3 - 48 months, Among the Combination group,3 case achieved complete remission (CR), 13 cases achieved partial remission (PR), 11 cases achieved stable disease (SD) and no cases had progressive disease (PD). The disease control rate (DCR) was 100%.Comparing the efficacy of sorafenib combination with interventional therapy and interventional mono-therapy, the longest follow-up time was 48 months vs 39 month; ORR was 59.3%(16/27)vs 62.8%(27/43),there was no statistical significant between the two groups (p>0.05).The result of the survival analyse showed the middle time to tumor progression was 24 and 56 weeks in the monotherapy group and the combination therapy group, respectively. there was conspicuous statistical significant between the two groups(p<0.01). Tumor markers APF Decreased after treatment in both two groups, and there was statistical significant between the two groups (p<0.05). half-year survival rate was 100% and 2-year survival rate was 70.4% in combination therapy group, half-year survival rate was 81.4% and 2-year survival rate was 41.9% in transarterial chemoembolization therapy group, and there was statistical significant between the two groups (p<0.05). The toxicity between the two groups is similar.TACE toxicity included: fever(46.5% vs 44.4%), Gastrointestinal side effects(32.6% vs 29.6%),Liver dysfunction (44.1% vs 40.7%),Upper abdominal pain(65.1% vs 70.4%), Puncture point injury(4.6% vs 3.7%). The major adverse events after using sorafenib were hand-foot skin reaction, diarrhea and thrombocytopenia and so on. hand-foot skin reaction(23 cases,85.2%, 1 cases Serious), Hypertension(12cases,44.4%), Diarrhea(5 cases,18.5%),Fatigue(8 cases,29.6%), all the adverse events can be Recoveried by appropriate treatment.CONCLUSION:The combined therapy of TACE and sorafenib is effective and well tolerated for advanced HCC.Comparing with interventional mono-therapy ,sorafenib combination with interventional therapy is more effective.1. It can prolong the survival rate of most patients.The half-year and 2-year survival rate increased clearly,and there was statistical significant between the two groups(p<0.05).2. The time to tumor progression prolonged obviously.3. Tumor marker AFP decreased clearly in combination therapy group.4. The adverse events in combination therapy group can be controlled and recoveried.
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