Abstract: Objective To investigate the efficacy of carlizumab combined with lenvatinib or apatinib in the treatment of advanced hepatocarcinoma and its influence on liver function and tumor markers.Methods A total of 96 patients with advanced hepatocarcinoma admitted to the First People's Hospital of Chuzhou between December 2019 and October 2021 were divided into two groups based on their treatment plan. The observation group consisted of 48 patients treated with camrelizumab combined with lenvatinib, while the control group consisted of 48 patients treated with camrelizumab combined with apatinib. The short-term efficacy of the two groups was compared by examining the serum leves of total bilirubin (TBil), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199) and α- L-fucosidase (AFU). Furthermore, patient survival was followed up for assessment.Results After treatment, the serum levels of TBil, AST, ALT in the observation group were (20.12±2.03) μmol/L, (43.58±4.12) U/L and (43.46±4.82) U/L, respectively. These levels were significantly lower than those in the control group [(22.06±3.19) μmol/L, (47.62±5.28) U/L, (46.55±6.13) U/L, (P<0.05)]. After treatment, the serum levels of AFP, CEA, CA199 and AFU in the observation group were (101.45±16.22) μg/L, (16.83±3.62) ng/mL, (143.21±21.65) U/mL, (35.02±5.69) U/L, respectively. These levels were significantly lower than those in the control group [(124.87±21.69) μg/L, (18.75±4.43) ng/mL, (166.21±35.16) U/mL, (38.36±7.84) U/L,(P<0.05)]. Additionally, the Objective response rate (ORR) and disease control rate (DCR) of group A were 50.00% and 83.33%, respectively, both of which were higher than those in the control group (33.33% and 68.75%, P<0.05). Furthermore, the median progression-free survival (PFS) in the observation group was 9.6 months, which was significantly longer than 6.2 months in the control group (P<0.05). There were no significant differences in the type and incidence of toxic and side effects between the two groups, and there were no drug withdrawal or drop-outs due to serious treatment-emergent adverse events.Conclusion The combination of camrelizumab with lenvatinib or apatinib in the treatment of advanced hepatocarcinoma has demonstrated promising results in protecting liver function and reducing the level of tumor markers. The toxicity and side effects of this treatment approach are relatively manageable. However, patients may benefit more in terms of survival from the combination of camrelizumab and lenvatinib than from the combination of camrelizumab and apatinib.

Key words: Advanced hepatocarcinoma, Camrelizumab, Lenvatinib, Apatinib, Liver function, Tumor markers