Clinical Study On Treatment Methods And Efficacy Of Advanced Hepatocellular Carcinoma

Aims:In order to summarize our clinical experiences in treating hepatocellular carcinoma(HCC),to provide the evidences for further research on individualized treatment,and to improve the treatment methods and regimen.We retrospectively collected the clinical data of patients with advanced HCC from our hospital,to systematically analyze the efficacy of different treatment methods and the relevant factors.Methods:A total of 259 HCC patients which were in the intermediate and advanced stages treated in our center from January 2006 to December 2018 were analyzed retrospectively.They were divided into six groups according to the different treatment methods.Group1:Untreated;Group 2:TACE only;Group 3:TACE + Sorafenib;Group 4:Liver resection only;Group 5:Liver resection + TACE;Group 6:Liver resection + TACE + Sorafenib.To systematically analyze the demographic characteristics,hepatitis background,Child-Pugh classification,disease staging,pathological classification,postoperative tumor-free survival,post-relapse survival,and overall survival of each group.The data were analyzed by Kaplan–Meier survival curve in SPSS 23.0,and the log-rank test was used for comparison between each group.Results:By univariate Kaplan-Meier software analysis,Child-Pugh classification,disease staging,pathological classification,presence or absence of microvascular invasion,and presence or absence of peripheral satellite lesions were significantly correlated with prognosis(P < 0.05).However,the gender,age,hepatitis background,and the size of lesion were not significantly correlated with prognosis(P>0.05).The 1,3,and 5 years overall survival rate were 67.6%,23.4%,and 10.0%,respectively.The medium survival time was 15 months.Compared between each group in the non-surgical group,the one-year survival rate and overall survival in the TACE only group and TACE + sorafenib group were better than those in the untreated group.The one-year survival rates were54.0%,71.4%,and 27.1%,respectively.The median survival times were 12,16 and 6.5 months,and the overall survival times were9.12 ± 9.54,14.48 ± 15.45,and 28.64 ± 24.33 months,respectively.The survival rate and overall survival of the surgical treatment group were better than those of the non-surgical group.The one-year survival rates in the liver resection only group,the liver resection + TACE group,and the liver resection + TACE +Sorafenib group were 85.0%,87.9%,and 100.0%,respectively.The median survival times were 24.7,26 and 47.8 months,and the overall survival times were 33.00 ± 25.56,29.39 ± 16.20,and 45.71± 25.35 months,respectively.The tumor-free survival time of the liver resection + TACE + Sorafenib group was significantly shorter than that of the liver resection only group,but the overall survival was significantly prolonged compared to the liver resection only group and the liver resection + TACE group.The median survival time after the recurrence was 7 months in the liver resection only group,14 Months in the liver resection + TACE group,and 22 months in the liver resection + TACE + Sorafenib group.Conclusion:Patients' Child-Pugh classification,HCC staging,pathological classification,presence or absence of microvascular invasion,and peripheral satellite lesions were all significantly correlated with prognosis.Surgical treatment can significantly prolong the survival time of patients with advanced HCC.The combination of surgery,TACE and Sorafenib has the best effect.For those inoperable patients,the efficacy of TACE or TACE + Sorafenib was significantly better than the untreated group,and TACE combined with sorafenib had a significant effect on the postoperative recurrence of HCC.