关键词: 程序性细胞死亡受体-1抗体, 靶向治疗, 肝动脉灌注化疗, 晚期肝癌, 肿瘤标志物, 不良反应

Abstract: Objective To explore the clinical efficacy of immune and targeted drugs combined with hepatic artery infusion chemotherapy（HAIC）in the treatment of advanced liver cancer．Methods A retrospective analysis was conducted on 78 patients with advanced liver cancer admitted to our hospital from January 2021 to January 2024．Among them,20 patients were treated with simple HAIC and divided into a single chemotherapy group．Thirty patients were treated with HAIC combined with PD-1 antibody,and divided into an immune group．Twenty-eight patients were treated with HAIC combined with PD-1 antibody immunotherapy and lenvatinib mesylate capsule targeted therapy,and divided into a combination group．The clinical efficacy of three groups,the expression levels of CEA,CA125,AFP,and incidence of adverse reactions before and after treatment were compared．Piper Fatigue Correction Scale（PFS-R）and the WHO QOL-BREF were used to assess cancer-related fatigue in both groups．The degree of fatigue and quality of life were assessed．Results The objective response rates of the simple chemotherapy group,the immune group,and the combination group were 15.00%,40.00% and 64.29%,respectively．The disease control rates were 30.00%,66.67% and 82.14%,respectively．The indicators above of the combination group was significantly higher than those in the simple chemotherapy group and the immune group（χ²=11.720,P=0.003;χ²=13.890,P<0.001;P<0.05）．After treatment,the levels of CEA,CA125 and AFP were all decreased in the three groups,and those in the combined group （CEA[13.62±4.24]ng/mL,CA125[31.62±13.66]U/mL,AFP：Ng/mL[35.21±5.93]）were lower than those in the immune group（17.85±3.32 ng/mL,59.26±9.35 U/mL,/ 42.12±4.12 ng/mL）and single chemotherapy group（23.73±4.79 ng/mL,64.57±5.23 U/mL,47.46±5.32]ng/mL）,the differences were statistically significant（F=7.698,P<0.001;F=11.480,P<0.001;F=14.952,P<0.001;P<0.05）．All patients had no grade 5 adverse reactions or severe liver function damage,and there was no statistically significant difference in the incidence adverse reactions such as thrombocytopenia,leukopenia,abdominal pain,vomiting,gastrointestinal bleeding,and anorexia among the three groups（P>0.05）．After treatment,the PFS-R score of the three groups was decreased,and the combined group（3.85±1.13）score was lower than that of the immune group（5.39±1.25）and the chemotherapy group（6.33±1.26）．While the WHOQOL-BREF score was increased,the score of combination group（348.58±66.12）was higher than that of immune group（297.24±72.21）and chemotherapy group（256.35±41.67）,and the difference was statistically significant（F=2.526,P=0.014;F=2.167,P=0.033;P<0.05）．Conclusions The combination of immune and targeted drugs with hepatic artery infusion chemotherapy has a significant therapeutic effect on advanced liver cancer．It can effectively control disease progression,reduce tumor marker levels in the body,improve patient quality of life,and alleviate cancer-related fatigue,with controllable safety．

Key words: programmed cell death receptor-1 antibody, targeted therapy, hepatic artery infusion chemotherapy, advanced liver cancer, tumor markers, adverse reactions