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

Table 1 Baseline characteristics of the patients with Ad-hepatocellular carcinoma who received camrelizumab plus apatinib and hepatic artery infusion chemotherapy therapy

Variables	Unmatched			PSM (1:1)
	TRIPLET alone group (n = 122)	TRIPLET-MWA group (n = 95)	P value	TRIPLET alone group (n = 82)	TRIPLET-MWA group (n = 82)	P value
Age, year			0.930			1.000
≤ 65	112 (91.80)	86 (90.53)		76 (92.68)	77 (93.90)
> 65	10 (8.20)	9 (9.47)		6 (7.32)	5 (6.10)	1.000
Gender			0.505
Female	12 (9.84)	13 (13.68)		8 (9.76)	9 (10.98)	1.000
Male	110 (90.16)	82 (86.32)		74 (90.24)	73 (89.02)
ECOG			0.900			1.000
0	122 (100.00)	94 (98.95)		82 (100.00)	81 (98.78)
1	0 (0.00)	1 (1.05)		0 (0.00)	1 (1.22)
Comorbidity			1.000			0.677
Absence	110 (90.16)	86 (90.53)		75 (91.46)	74 (90.24)
Presence	12 (9.84)	9 (9.47)		7 (8.54)	8 (9.76)
HBV			0.407			1.000
Absence	6 (4.92)	2 (2.11)		4 (4.88)	2 (2.44)
Presence	116 (94.26)	93 (95.79)		78 (95.12)	80 (97.56)
Ascites			0.011a			1.000
Absence	93 (76.23)	87 (91.58)		75 (91.46)	75 (91.46)
Presence	29 (22.95)	8 (8.42)		7 (8.54)	7 (8.54)
ALBI grade			0.041a			0.867
1	67 (54.92)	66 (69.47)		55 (67.07)	57 (69.51)
2-3	55 (45.08)	29 (30.53)		27 (32.93)	25 (30.49)
HCC number			0.277			0.219
1-3	54 (44.26)	50 (52.63)		50 (70.42)	42 (59.15)
> 3	68 (55.74)	45 (47.37)		21 (29.58)	29 (40.85)
HCC diameter, cm			0.667			0.155
< 5	7 (5.74)	6 (6.32)		7 (8.54)	4 (4.88)
5-10	51 (41.80)	34 (35.79)		41 (50.00)	32 (39.02)
> 10	64 (52.46)	55 (57.89)		34 (41.46)	46 (56.10)
AFP, ng/mL			0.605			0.428
≤ 400	46 (37.70)	40 (42.11)		31 (37.80)	37 (45.12)
> 400	76 (62.30)	55 (57.89)		51 (62.20)	45 (54.88)
Vascular invasion			0.077			0.346
Absence	18 (14.75)	24 (25.26)		15 (18.29)	21 (25.61)
Presence	104 (85.25)	71 (74.74)		67 (81.71)	61 (74.39)
Metastasis			0.750			0.158
Absence	68 (55.74)	50 (52.63)		50 (60.98)	40 (48.78)
Presence	54 (44.26)	45 (47.37)		32 (39.02)	42 (51.22)
AST ‎(U/L)‎, median, IQR	67 (31, 105)	77 (32, 112)	0.854	85 (28, 128)	77 (35, 127)	0.872
ALT ‎(U/L)‎‎, median, IQR	54 (22, 89)	59 (22, 89)	0.746	58 (22, 89)	59 (25, 109)	0.929
TBIL (μmol/L), mean ± SD	17.8	23.2	0.422	18.6	19.0	0.710
ALB (g/L), mean ± SD	37.0 ± 5.1	37.6 ± 4.2	0.564	37.2 ± 53	37.0 ± 4.2	0.567
INR, mean ± SD	1.1 ± 0.12	1.12 ± 0.10	0.901	1.10 ± 0.14	1.11 ± 0.10	0.892
PT (s), mean ± SD	12.4 ± 0.3	12.3 ± 0.6	0.940	12.4 ± 0.8	12.4 ± 0.6	1.000
PLT (× 109)‎, median, IQR	208(59, 245)	256 (67, 312)	0.358	230 (55, 270)	256 (78, 304)	0.660

^aP value < 0.05 suggest statistically significant differences.

Data are number of patients; data in parentheses are percentage unless otherwise indicated. Data in bracket was percent of patients. The quantitative data with mean ± SD or median with interquartile range were compared by the Kruskal-Wallis test. The qualitative data in two groups were compared by using the χ² test. HCC: Hepatocellular carcinoma; TRIPLET: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy; MWA: Microwave ablation; PSM: Propensity score match; ECOG: Eastern Cooperative Oncology Group; HBV: Hepatitis B virus; AFP: α-fetoprotein; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PT: Prothrombin time; INR: International normalized ratio; TBIL: Total bilirubin; PLT: Platelet; IQR: Interquartile range.

Table 2 Microwave ablation parameters after camrelizumab plus apatinib and hepatic artery infusion chemotherapy for advanced hepatocellular carcinoma

Parameters	MWA (n = 95)
Ablation of residual tumor activity	63 (66.3)
Ablation of recurrent tumor	32 (33.7)
Maximum tumor diameter (cm)
≤ 5	58 (61.1)
> 5	37 (38.2)
No. of tumor
Single	74 (77.9)
Multiple	21 (22.1)
Extrahepatic metastasis before MWA	65 (68.4)
Ablation of tumor type number
1	73 (76.8)
2	19 (20)
> 2	3 (3.2)
Ablation of liver tumor	92 (96.8)
Ablation of lung tumor	13 (13.7)
Ablation of adrenal gland tumor	3 (3.2)
Ablation of breast tumor	1 (1.1)
Hepatic tumors
Ablative duration (minute)	26
Ablative power (W)	55.8 ± 6
Ablative sessions	2
Ablative points	4
Lung tumors
Ablative duration (minute)	14
Ablative power (W)	50.2 ± 3.4
Ablative sessions	1
Ablative points	2
Adrenal gland tumors
Ablative duration (minute)	20
Ablative power (W)	45.6 ± 4.2
Ablative sessions	1
Ablative points	1
Breast tumors
Ablative duration (minute)	16
Ablative power (W)	50
Ablative sessions	1
Ablative points	2
The response to HAIC
CR	8 (8.4)
PR	78 (82.1)
SD	9 (9.5)
Complete ablation of hepatic tumors	57 (60)
Complete ablation of all tumors	34 (35.8)
Recurrence after MWA	57 (60)
Combination of radiotherapy	8 (8.4)

Data are number of patients; data in parentheses are percentage unless otherwise indicated. Data in bracket was percent of patients. HCC: Hepatocellular carcinoma; MWA: Microwave ablation; HAIC: Hepatic arterial infusion chemotherapy; CR: Complete response; PR: Partial response; SD: Stable disease.

Table 3 Theraputic effectiveness comparison between camrelizumab plus apatinib and hepatic artery infusion chemotherapy group and camrelizumab plus apatinib and hepatic artery infusion chemotherapy-microwave ablation group

Variables	TRIPLET group (n = 122)	TRIPLET-MWA group (n = 95)	P value	TRIPLET group (n = 82)	TRIPLET-MWA group (n = 82)	P value
Hepatic response
Tumor response to the first TRIPLET			0.062			0.120
Non-OR	90 (73.77)	54 (60.67)		58 (70.73)	45 (57.69)
OR	32 (26.23)	35 (39.33)		24 (29.27)	33 (42.31)
The optimal tumor response			< 0.001			0.007
Non-OR	38 (31.15)	9 (9.47)		21 (25.61)	7 (8.54)
OR	84 (68.85)	86 (90.53)		61 (74.39)	75 (91.46)	0.006
Overall response			0.001
Non-OR	46 (37.70)	15 (15.79)		28 (34.15)	12 (14.63)
OR	76 (62.30)	80 (84.21)		54 (65.85)	70 (85.37)
HAIC sessions1	4 (2, 6)	4 (2, 6)	1.000	4 (2, 6)	4 (2, 6)	1.000
Interval between TRIPLET and MWA, day1		40 (32, 53)			36 (32, 48)

¹The qualitative data using median with interquartile range in two groups were compared by using the χ² test.

Data are number of patients; data in parentheses are percentage unless otherwise indicated and data in bracket was percent of patients. TRIPLET: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy; HCC: Hepatocellular carcinoma; HAIC: Hepatic arterial infusion chemotherapy; MWA: Microwave ablation; PSM: Propensity score match; OR: Objective response.

Table 4 Complications comparison related to camrelizumab plus apatinib and hepatic artery infusion chemotherapy or camrelizumab plus apatinib and hepatic artery infusion chemotherapy-microwave ablation

Complications	TRIPLET alone group (n = 122)	TRIPLET-MWA group (n = 95)	P value
Major complications	6 (4.9)	5 (5.3)	1.000
Peritoneal effusion	1 (0.8)	-
Liver abscess	3 (2.5)	1 (1.1)
Biliary fistula	1 (0.8)	-
Biloma	-	2 (2.0)
Hydropneumothorax requiring drainage	-	-
Massive ascites	1 (0.8)	1 (1.1)
Seeding	-	1 (1.1)
Minor complications	36 (29.5)	22 (23.2)	0.755
Liver dysfunction	18 (14.8)	12 (12.6)
Fever	18 (14.8)	10 (10.5)
Abdominal nonspecific pain	3 (2.4)	1 (1.1)
Bile duct dilatation	1 (0.8)	2 (2.0)
Hemorrhage	5 (4.0)	3 (3.2)
Mild pleural effusion	10 (8.1)	-
Mild ascites	6 (4.8)	3 (3.2)
Jaundice	4 (3.2)	3 (3.2)
Other	7 (5.7)	4 (4.0)

Unless otherwise indicated, data are number of patients. Data in parentheses are percentages and were calculated by using the total number of patients in each group as the denominator. TRIPLET: Camrelizumab plus apatinib and hepatic artery infusion chemotherapy; MWA: Microwave ablation.