Zhongguo quanke yixue (Nov 2024)
The Value of Serum VEGF in Evaluating the Clinical Efficacy of TACE Alone or Combined with Target Immunotherapy in Advanced Hepatocellular Carcinoma
Abstract
Background The treatment of intermediate and advanced-stage hepatocellular carcinoma poses significant challenges, prompting a research focus on the effective evaluation and enhancement of therapies. Transarterial chemoembolization (TACE) combined with immunotherapy has exhibited potential, however, there is a need for further validation of its efficacy and the identification of biomarkers that can predict patient prognosis. Objective To explore the clinical value of serum vascular endothelial growth factor (VEGF) in evaluating the clinical efficacy of TACE alone or combined with target immunotherapy in advanced hepatocellular carcinoma. Methods The clinical data of 113 newly diagnosed patients with advanced hepatocellular carcinoma were hospitalized in the Third Hospital of Hebei Medical University from January 2021 to July 2022 were analyzed. According to the treatment regimen, the patients were divided into TACE group (n=66), TACE combined targeting group (n=22), and TACE combined with target immunity group (n=25). Tumor markers such as VEGF, alpha fetoprotein (AFP), and protein induced by vitamin K antagonist-Ⅱ (PIVKA-Ⅱ) were detected before and after treatment. According to the modified response evaluation criteria in solid tumors (mRECIST), patients were followed up for 3, 6, and 12 months after treatment to evaluate the clinical efficacy of advanced hepatocellular carcinoma. The objective response rate (ORR) and disease control rate (DCR) of the patients were analyzed. The median progression free survival (PFS) was calculated by the Kaplan-Meier and the survival curve was drawn. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum VEGF and related combined serum tumor markers for the clinical efficacy of advanced hepatocellular carcinoma. Results The ORRs of the TACE group, TACE combined targeting group and TACE combined target immunity group were after 12 months of follow-up were 17.14% (6/35), 33.33% (4/12), and 54.55% (6/11), respectively, and the DCRs were 28.57% (10/35), 41.67% (5/12), and 72.73% (8/11), respectively. The ORR and DCR of the TACE combined target immunity group after 12 months of treatment were significantly higher than those of the TACE group, with statistically significant differences (P<0.05). The median PFS of TACE combined with target immunity group (15.039 months) was better than that of TACE group (8.757 months) and TACE combined targeting group (9.680 months) (P<0.05). The frequency of TACE in TACE combined with target immunity group after 12 months of follow-up was significantly less than that in TACE groupand TACE combined targeting group (P<0.05). The difference of serum VEGF before and after treatment in TACE combined targeting group and TACE combined target immunity group was significantly higher than that in TACE group, and the difference was statistically significant (P<0.05). The AUC of the difference in serum VEGF before and after treatment for predicting the clinical efficacy of advanced hepatocellular carcinoma was 0.748 (P<0.001), and the sensitivity and specificity were 0.909 and 0.629, respectively. The AUCs of serum VEGF combined with PIVKA-Ⅱ, VEGF combined with AFP, and VEGF combined with AFP and PIVKA-Ⅱ for predicting the clinical efficacy of advanced hepatocellular carcinoma were 0.781, 0.869, and 0.872, respectively (P<0.001) . Conclusion TACE combined with targeted immunotherapy can improve the efficacy of patients with advanced hepatocellular carcinoma and prolong the PFS of patients. Serum VEGF in patients can be used as a biological indicator for evaluating clinical efficacy.
Keywords
