| ObjectiveHepatocellular carcinoma is one of the most common malignant tumors in the world and is the third cause of cancer related deaths.In recent years,the incidence of liver cancer is gradually increasing in China and the number of patients accounts for about 50%of the world,and 70%-85%of hepatocellular carcinoma cases are diagnosed at an intermediate and advanced stage,losing the opportunity of resection.According to Barcelona Clinic Liver Cancer(BCLC)system and Guidelines for the diagnosis and treatment of primary liver cancer in China,the standard treatment for intermediate and advanced hepatocellular carcinoma is combined therapy with transcatheter arterial chemoembolization(TACE).Sorafenib was recommend as the first-line option for the treatment of advanced liver cancer,but surafenib clinical efficacy is low and patient’s overall survival time after treatment was shorter than expected,which greatly limited its clinical application.Apatinib is a new type of anti-angiogenic drug independently developed by China,Many Phase Ⅱ and Ⅲclinical trials have confirmed that apatinib has certain clinical efficacy on various solid tumors such as gastric cancer,breast cancer and primary liver cancer,but there are relatively few comparative studies on apatinib combination with TACE in the treatment of intermediate and advanced hepatocellular carcinoma.In this paper,the safety and clinical efficacy of transcatheter arterial chemoembolization(TACE)combined with apatinib in the treatment of intermediate and advanced hepatocellular carcinoma were preliminarily discussed,and the factors influencing the survival and prognosis of the patients were analyzed.MethodsClinical data of 98 patients with intermediate and advanced hepatocellular carcinoma received at our hospital from January 2016 to January 2018 were collected and all patients who were admitted at our research were unsuitable for surgery treatment or refused surgery treatment.According to different treatment schemes,they were divided into TACE treatment alone group(n=56)and TACE combined with apatinib treatment group(n=42).In the TACE combined with apatinib treatment group,daily oral apatinib doses of 250 mg and 500 mg were 13 and 29,respectively.The therapeutic efficiency,disease control rate,progression-free survival time,overall survival time,change of AFP,incidence of adverse reactions and improvement of quality of life of patients in TACE combined with apatinib treatment group and TACE treatment alone group were compared.Results1.The ORR of the TACE treatment alone group was 26.79%,and the DCR was 55.36%.The ORR and DCR of the TACE combined with apatinib treatment group were 47.62%and 78.57%respectively.There was statistically significant difference in ORR and DCR between the two groups(P<0.05).2.In the TACE combined with apatinib treatment group,patients with AFP decreased by more than 50%account for 61.90%(26/42).while in the TACE treatment alone group,patients with AFP decreased by more than 50%only account for 39.29%(22/56),there was statistically significant difference between the two groups(P<0.05).3.The mPFS and mOS in the TACE treatment group were 5.3 months and 10.6 months respectively,while in the TACE combined with apatinib treatment group the mPFS and mOS were 7.9 months and 16.8 months respectively.mPFS and mOS in the combined treatment group were significantly longer than in the TACE treatment alone groups(P<0.05).4.The analysis results of prognostic factors suggested that HBV positive,BCLC stage C and portal vein carcinoma suppository were independent prognosis risk factors of PFS and OS,combined oral apatinib treatment was a prognosis protective factor for PFS and OS.5.The main adverse reactions after TACE treatment were fever,elevated blood pressure,upper abdominal pain,etc.there was no statistically significant difference in the incidence of adverse reactions after TACE treatment between the two groups(P>0.05).6.The main side reactions of oral apatinib treatment were hand-foot-skin reaction(20/42,47.61%),diarrhea(15/42,35.71%),hypertension(22/42,52.38%),fatigue(18/42,42.86%),etc.The incidence of 3-4 level adverse reaction is 23.81%(10/42).Including 2 cases of hand-foot-skin reaction,2 cases of diarrhea,3 cases of hypertension,1 case of proteinuria,lcase of leucopenia and lcase of thrombocytopenia.None of patients died due to severe drug toxic reactions.7.In the TACE group,11,35,and 10 patients had an ECOG score before treatment of 0,1,and 2 points,respectively,after treatment,12,37,and 7 patients had an ECOG score of 0,1,and 2 points,respectively.In the TACE+ apatinib group,8,25,and 9 patients had an ECOG score before treatment of 0,1,and 2 points,respectively,after treatment,10,28,and 4 patients had an ECOG score of 0,1,and 2 points,respectively.In each group the ECOG score after treatment changed slightly compared with the score before treatment in each group,although the change was not statistically significant(P>0.05).8.In the TACE combined with apatinib treatment group there was no statistically significant difference in mPFS and mOS between the oral apatinib dose of 250mg and 500mg(P>0.05).Conclusion1.TACE combined with apatinib has good safety and mild adverse reactions in the treatment of intermediate and advanced hepatocellular carcinoma.2.Compared with TACE treatment alone,TACE combined with apatinib treatment can get better clinical efficacy and significantly improve the objective response rate and disease control rate in the treatment of intermediate and advanced hepatocellular carcinoma.3.Compared with TACE treatment alone,TACE combined with apatinib treatment can prolong the disease-free progression time and the overall survival time in the treatment of intermediate and hepatocellular carcinoma.4.The analysis results of prognostic factors suggested that HBV positive,BCLC stage C and portal vein carcinoma suppository were independent prognosis risk factors of PFS and OS,combined oral apatinib treatment was a prognosis protective factor for PFS and OS. |
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