Camrelizumab, apatinib and hepatic artery infusion chemotherapy combined with microwave ablation for advanced hepatocellular carcinoma

Figure 1 The illustrated flowchart of selecting patient for comparing between camrelizumab plus apatinib and hepatic artery infusion chemotherapy alone and camrelizumab plus apatinib and hepatic artery infusion chemotherapy combined with microwave ablation treatment in patients with advanced hepatocellular carcinoma. HCC: Hepatocellular carcinoma; MWA: Microwave ablation; TRIPLET: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy; SR: Liver resection surgery; HAIC: Hepatic arterial infusion chemotherapy; PSM: Propensity score matching.

Figure 2 An example of follow-up medical record of camrelizumab plus apatinib and hepatic artery infusion chemotherapy treatment in hepatocellular carcinoma patients with tumor thrombus of right inferior portal vein. A 48-year-old male patient with hepatocellular carcinoma (triangle) were examined [the maximum diameter, 13.1 cm; location in S4/8; alpha-fetoprotein (AFP), > 121000 ng/mL] by contrast enhanced magnetic resonance imaging scanning on July 2021. A-C: Preoperative scan [T1WI portal phase]; D-F: After two-cycle camrelizumab plus apatinib and hepatic artery infusion chemotherapy (TRIPLET), the tumor (triangle) has shrunk (the maximum diameter, 7.7 cm; AFP, 10616.0 ng/mL) (T1WI portal phase); G-I: After four-cycle TRIPLET, the tumor (triangle) has shrunk significantly (the maximum diameter, 7.0 cm; AFP, 6183.00 ng/mL) (T1WI portal phase).

Figure 3 An example of follow-up medical record of camrelizumab plus apatinib and hepatic artery infusion chemotherapy combined with microwave ablation treatment in patients with advanced hepatocellular carcinoma. A 54-year-old male patient with hepatocellular carcinoma (triangle) were examined [the maximum diameter, 8.7 cm; alpha-fetoprotein (AFP), 1765 ng/mL] by contrast enhanced computed tomography scanning on September 2020. A and B: The tumor was diffusely distributed (triangle) and the right main branch of portal vein showed filling defect (arterial phase and portal phase); C-E: After four-cycle camrelizumab plus apatinib and hepatic artery infusion chemotherapy, the tumor (triangle) has shrunk significantly, but the tumor periphery remained active (triangle) and showed enhanced activity [T2-weighted imaging (T2WI), T1WI arterial phase and portal phase]; F and G: The residual lesions were ablated by two microwave antennas at the same time. The ablation power was 60 W and the ablation time was 10 minutes; H and I: Six months after microwave ablation, magnetic resonance imaging (T1WI arterial phase and portal phase) showed that the tumor activity had completely disappeared (triangle) and the tumor markers had returned to normal.

Figure 4 Comparing the survival of camrelizumab plus apatinib and hepatic artery infusion chemotherapy alone and camrelizumab plus apatinib and hepatic artery infusion chemotherapy combined with microwave ablation treatment for patients with advanced hepatocellular carcinoma. A-D: Kaplan-Meier curves for the overall survival (OS) (A), progression-free survival (PFS) (B), intrahepatic PFS (IPFS) (C) and extrahepatic PFS (EPFS) (D) of patients with advanced hepatocellular carcinoma before propensity score matching (PSM); E-H: Kaplan-Meier curves for the OS (E), PFS (F), IPFS (G) and RPFS (H) of patients with advanced hepatocellular carcinoma after PSM. T-M: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy combined with MWA; T-A: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy alone; OS: Overall survival; PFS: Progression-free survival; IPFS: Intrahepatic progression-free survival; EPFS: Extrahepatic progression-free survival; HR: Hazard ratio; CI: Confidence interval.

Figure 5 Forest plot showing the factors associated with overall survival and progression-free survival in patients with advanced hepatocellular carcinoma who received camrelizumab plus apatinib and hepatic artery infusion chemotherapy alone and camrelizumab plus apatinib and hepatic artery infusion chemotherapy combined with microwave ablation. A: Overall survival in all patients; B: Progression-free survival in all patients. T-M: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy combined with MWA; T-A: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy alone; HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; AFP: α-fetoprotein; ALBI: Ascites and albumin-bilirubin.