Clinical Efficacy Of TACE Combined With Targeted And Immunotherapy In The Treatment Of Unresectable Primary Liver Cancer

Objective To study the therapeutic effect of TACE combined with targeted and immunotherapy for unresectable primary liver cancer,the purpose of this study is to provide guidance for the treatment of unresectable primary liver cancer patients.Methods Patients with unresectable primary liver cancer who received selective hepatic artery embolization(TACE)combined with targeted and immunotherapy in the General Hospital of Ningxia Medical University from January 2020 to January 2022 were selected.Record the general situation of patients,including sex,age,first TACE time,BCLC stage,Child-Push grade of liver function,tumor diameter,tumor blood supply,laboratory examination(blood routine,liver function,coagulation function,AFP,etc.)and imaging examination follow-up results(number of tumor lesions and their enhanced diameter),etc.After screening according to inclusion and exclusion criteria,23 patients were divided into simple TACE treatment group according to all the treatment methods they received at the end of follow-up;TT Group,TACE combined with targeted therapy(sorafenib or lamvatinib),22cases;22 patients were treated with TACE combined with targeted therapy(sorafenib or lenvatinib)and immunotherapy(cindilimab),referred to as TTI group.The patients were followed up by telephone,outpatient and inpatient system,and the data were collected and analyzed statistically by SPSS 26.0.Results 1.Sixty-seven patients with unresectable primary liver cancer were enrolled in this study,including 55 males(82.09%),12 females(17.91%),aged 22-76 years.There was no significant difference in general data and laboratory examination among the three groups(P > 0.05),but the data of the three groups were comparable.2.There was no significant difference in the times of TACE,D-TACE and embolism syndrome,pain,fever,nausea and vomiting after TACE among the three groups(P > 0.05).Postoperative adverse reactions were controlled or relieved after treatment,and no patient died of serious adverse reactions.3.Comparison of curative effects:(1)One month after TACE,the objective remission rate(72.73%)and disease control rate(95.45%)in TTI group were higher than those in TT group(63.64%)and disease control rate(86.36%),while the objective remission rate(63.64%)and disease control rate(86.36%)in TT group were higher than those in TACE group(52.17%)and disease control rate(78.26%),but there was no significant difference among the three groups(P > 0.05).3 months after TACE: The objective remission rate(77.27%)and disease control rate(95.45%)in TTI group were higher than those in TT group(72.73%)and disease control rate(90.90%).The objective remission rate(72.73%)and disease control rate(90.90%)in TT group were higher than those in TACE group(60.87%)and disease control rate(78.26%),but there was no significant difference among the three groups(P > 0.05).(3)6 months after TACE: The objective remission rate(72.73%)and disease control rate(86.36%)in TTI group were higher than those in TT group(54.44%)and disease control rate(77.27%).The objective remission rate(54.44%)and disease control rate(77.27%)of TT Group were higher than those of TACE Group(34.78%)and disease control rate(52.17%).The difference between TTI Group and TACE Group was statistically significant(P < 0.05),the difference between TTI Group and TACE Group was statistically significant(P < 0.05),the difference between TTI Group and TT Group was not statistically significant(P > 0.05),and the difference between TT Group and TACE Group was not statistically significant(P > 0.05).(4)12 months after TACE: The objective remission rate(59.09%)and disease control rate(72.73%)in TTI group were higher than those in TT group(36.36%)and disease control rate(40.91%).The objective remission rate(36.36%)and disease control rate(40.91%)of TT Group were higher than those of TACE Group(21.74%)and disease control rate(34.78%).The difference between TTI Group and TACE Group was statistically significant(P < 0.05),the difference between TTI Group and TACE Group was statistically significant(P < 0.05),the difference between TTI Group and TT Group was not statistically significant(P > 0.05),and the difference between TT Group and TACE Group was not statistically significant(P >0.05).4.Comparison of survival time: The median OS(19.91 months)and median PFS(13.35months)in TTI group were longer than those in TT group(15.46,8.28 months)(P < 0.05),the median OS(15.46 months)and median PFS(8.28 months)in TT group were longer than those in TACE group(11.93,6.23 months)(P < 0.05),and the median OS and median PFS in TTI group were longer than those in TACE group(P < 0.05).5.Comparison of one-year survival rate: The one-year survival rate of TACE group(50.00%),TT group(63.6%)and TTI group(86.4%);The difference of survival rate among the three groups(P < 0.05)was as followsThere was no significant difference between TACE Group and TT Group(P > 0.05),no significant difference between TT Group and TTI Group(P > 0.05),and significant difference between TACE Group and TTI Group(P < 0.05).Conclusion 1.TACE combined with targeting and immunotherapy is an effective treatment for unresectable primary liver cancer.2.TACE combined with targeted immunotherapy is more effective than TACE group in sequential treatment for more than 6months,and the difference in therapeutic effect is greater than TACE group.