A clinical study of targeted immunotherapy combined with hepatic arterial chemoembolization in the treatment of liver injury associated with primary liver cancer
10.3760/cma.j.cn501113-20230915-00109
- VernacularTitle:靶免联合经动脉插管化疗栓塞术治疗原发性肝癌相关肝损伤的临床研究
- Author:
Lingdi LIU
1
;
Shiming DONG
;
Yuanyuan LI
;
Yuemin NAN
Author Information
1. 河北医科大学第三医院中西医结合肝病科 河北省慢性肝病肝纤维化研究重点实验室 河北省国际科技合作基地——河北省肝癌分子诊断国际联合研究中心，石家庄 050051
- Keywords:
Hepatocellular carcinoma;
Transcatheter arterial chemoembolization;
Combination of targeted therapy and immunotherapy;
Liver injury;
Prediction model
- From:
Chinese Journal of Hepatology
2023;31(11):1156-1162
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the conditions of occurrence and factors influencing liver injury caused by molecular targeted drugs and immune checkpoint inhibitors combined with hepatic arterial chemoembolization (TACE) in the treatment of primary liver cancer.Methods:105 cases of primary liver cancer admitted to the Third Hospital of Hebei Medical University from January 2020 to June 2023 were selected. Patients liver biochemical indicators conditional changes before and after treatment with targeted drugs+TACE and targeted drugs+immune checkpoint inhibitors (ICIs)+TACE were analyzed. Liver injuries above grade 2 and its independent risk factors to predict and evaluate model accuracy were established. Independent samples t-test, analysis of variance, and rank sum test were used for comparison of measurement data between groups. Count data were compared with a χ2 test between groups. Results:A total of 50 (47.62%) of the 105 cases developed liver injury during the treatment course, with 26 (52%) cases of first-grade liver injury, 16 (32%) cases of second-grade liver injury, 8 (16%) cases of third-grade liver injury, and none of fourth-grade liver injury. There was no statistically significant difference in the incidence of liver injury between the two groups of patients ( χ2=1.299, P = 0.637). Multivariate logistic regression analysis showed that total bilirubin, prealbumin, and prothrombin activity were independent risk factors for the occurrence of liver injury. The total bilirubin-prealbumin-prothrombin activity (TAP) model was established. TAP diagnosis of grade 2 or higher liver injury had an area under the receiver characteristic curve of 0.935, sensitivity of 84.35%, and specificity of 92.31% at a cut-off value of 1.24, and significantly better diagnostic performance than albumin-bilirubin (ALBI) grade. Conclusion:The occurrence of severe liver injury is minimal and well tolerated in the targeted drug + TACE treatment group and targeted drug + ICIs + TACE treatment group. The TAP model can be used as a new method to assess the risk of liver injury above grade 2 in patients treated with targeted immunotherapy combined with TACE.
