| Objective:To investigate the clinical efficacy and safety of an arteriovenous joint applied for arsenic trioxide combined with transcatheter arterial chemoembolization(TACE)in the treatment of advanced primary hepatocellular carcinoma(HCC).Methods:Clinical data of 75 patients with primary hepatocellular carcinoma in BCLC stage B and C and liver-grading in Child-Pugh grades A and B diagnosed at our hospital from December 2015 to February 2017 was retrospectively analyzed.All patients met the diagnostic criteria for hepatocellular carcinoma in the 2017 edition of Primary Hepatocellular Carcinoma and did not receive other antitumor treatments(ablation,targeted therapy,etc.)prior to the first treatment.According to the different treatment options,38 cases in the observation group(group A)and 37 cases in the control group(group B)were treated with TACE.All the patients were initially treated with oxaliplatin 100 mg/m2,5-FU1g/m2,and then arsenic trioxide powder 20mg dissolved in2ml lidocaine,and then with lipiodol(5-20ml)emulsified embolization embolization,depending on the situation to append appropriate amount of gelatin sponge or PVA particles,the patients in group A TACE perioperative period plus arsenic trioxide intravenous infusion of 7 days(ATO10mg+500ml saline,intravenous infusion of 4-5h qd,3 days before surgery,4 days after surgery).Patients in both groups underwent the second TACE 4-6 weeks after the first treatment.Two groups of patients completed at least 2 TACE treatments according to the treatment regimen.After every 8 weeks to review,including liver function,renal function,AFP,blood and upper abdomen enhanced CT or MRI and other tests,according to the results of the review to determine whether the need for re-treatment and treatment interval.Follow the two groups for 1 year and above to observe the clinical efficiency,disease control rate,life span,AFP,quality of life,adverse reactions and safety.result:1.The objective and effective rate of group A was 52.6%,disease control rate was 89.5%;group B objective response rate was 45.9%,disease control rate was 81.1%,ORR and DCR were higher than those in group B,but there was no significant difference between the two groups(P>0.05).2.The 12-month and 18-month survival rates in group A and group B were 97.2%,94.2%,63.5%and 37.4%respectively.The median survival time was 20 and 16 months in both groups,with statistically significant differences in survival(X~2=8.843,P=0.003).The median progression-free survival time was 11 and 8 months in both groups,with significant difference(X~2=18.203,P=0.001).3.The two groups of patients with adverse reactions mainly manifested fever,gastrointestinal reactions,liver pain,myelosuppression and liver damage,mainly 0 to 2 level,patients with multiple tolerance,and no grade 4 adverse reactions.Myelosuppression mainly manifested as leucopenia and anemia,liver damage mainly manifested as elevated aminotransferases,gastrointestinal reactions were mainly nausea,vomiting,diarrhea,etc.There was no significant difference between groups(P>0.05).The adverse reactions improved or disappeared after symptomatic treatment.The two groups of patients did not appear irreversible toxicity.4.Serum AFP decreased after treatment in both groups,25 cases and18 cases,the rate of decline was 83.3%and 58.1%,the difference was statistically significant(X~2=4.680,P<0.05);before and after treatment,serum AFP levels(P<0.001).There was no significant difference between the two groups in serum AFP levels after treatment(P>0.05).A total of188 TACEs were performed in 75 patients,2-5 beats/case,and the median number of embolizations was twice.A total of 75 interventions were performed in group A,with an average of 2.0 times.In group B,111were interventions with an average of 3.1 The difference between the two groups was statistically significant(P<0.001).The quality of life of two groups of patients after treatment,the difference was statistically significant(X~2=6.477,P=0.011).5.Univariate analysis showed that Child-Pugh classification,pretreatment serum AFP level,portal vein tumor thrombus,number of TACE,preoperative tumor size,cirrhosis,tumor capsule integrity and distant metastasis were correlated with prognosis(P<0.05).The gender,age,BCLC stage and ECOG score had no relation with the prognosis(P>0.05).Multivariate analysis showed that the number of TACE treatment(HR=0.787,95%CI:0.630~0.982)was an independent protective factor.The size of preoperative tumor(HR=1.607,95%CI:1.374~1.879),Child-Pugh classification(HR=2.518,95%CI:0.609~10.412),with or without portal vein tumor thrombus(HR=4.078,95%CI:3.222~7.025)Pre-embolic serum AFP?400ng/ml(HR=2.159,95%CI:0.999~2.001)were independent risk factors.Conclusion:1.An arteriovenous joint applied for arsenic trioxide combined with transcatheter arterial chemoembolization in the treatment of advanced primary hepatocellular carcinoma has a good clinical effect,which can improve the patient's survival rate,prolong the overall survival progression-free survival.2.An arteriovenous joint applied for Arsenic Trioxide Combined with transcatheter arterial chemoembolization in the treatment of advanced primary hepatocellular carcinoma clinical efficacy is superior to simple arterial application in TACE.3.An arteriovenous joint applied for Arsenic Trioxide Combined with TACE in the treatment of advanced primary hepatocellular carcinoma can significantly reduce the level of serum AFP,improve patient quality of life,no irreversible side effects,safe and effective,is available for the treatment of advanced hepatocellular carcinoma patients better treatment Program. |
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