Abstract: Objective To compare the clinical efficacy of transcatheter arterial chemoembolization (TACE) in our hospital, hepatic arterial infusion chemotherapy (HAIC) combined with cindilizumab and bevacizumab injection in the treatment of unresectable primary liver cancer (PLC). Methods Between January 2019 and June 2023 in our hospital, 80 patients with unresectable PLC were analyzed. According to the differences in treatment strategies, the included cases were divided into TACE group and HAIC group, with 40 cases in each group. The two groups were combined with cindilizumab and bevacizumab injection on the basis of TACE or HAIC, and the differences in short-term efficacy, liver function, tumor markers, T lymphocyte subsets, adverse reactions and overall survival rate were compared between the two groups. Results The objective remission rate (Complete Response (CR) + Partial Response (PR)/all cases) and disease control rate (CR + PR + Stable Disease (SD)/all cases) in HAIC group were 55.0% and 82.5%, which were significantly higher than those in TACE group [35.0% and 67.5%, P<0.05]. The alpha-fetoprotein (AFP), alpha-fetoprotein Lens culinaris agglutinin 3 (AFP-L3), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) in TACE group were 184.6 (96.0, 271.9) ng/mL, 176.4 (99.5, 248.7) ng/mL, 98 (70, 137) U/L, 93 (75, 123) U/L and 74.8(37.8, 113.5) μmol/L, which had a significantly difference when comparing with HAIC group [86.4 (60.3, 123.6) ng/mL, 226.2 (110.8, 301.2) ng/mL, 56 (32, 80) U/L, 50 (35, 71) U/L and 41.8 (25.6, 301.2) μmol/L, P<0.05). After treatment, CD4⁺ and CD4⁺/CD8⁺ in HAIC group were 38.5(35.0, 39.8) % and 1.3(1.2, 1.4), which were statistically different from those in TACE group [35.2(34.0, 36.8) % and 1.2(1.0, 1.2)]. After TACE and HAIC treatment, some cases had treatment-related nausea and vomiting, abdominal pain and low fever, which were improved and relieved after symptomatic treatment. Seven cases of fever, four cases of capillary hyperplasia, three cases of anemia and two cases of hypothyroidism occurred in the two groups after receiving immunotherapy. None of the above cases with adverse reactions received follow-up immunotherapy. After 1 year of treatment, follow-up was conducted, with 3 cases lost to follow-up in the TACE group and 1 case lost to follow-up in the HAIC group. The overall survival rates were 64.9% (24/37) and 41.0% (16/39), with statistical significance (P<0.05). Conclusion After HAIC treatment, the combination of cindilizumab and bevacizumab injection in the treatment of advanced PLC patients has an ideal short-term effect. Under the premise of ensuring the safety of medication, the overall survival situation has improved significantly, which is worthy of a further observation by expanding clinical samples.

Key words: Primary liver cancer, Hepatic arterial infusion chemotherapy, Transcatheter arterial chemoembolization, Cindilizumab, Bevacizumab