Abstract: Objective To investigate the clinical effect of transhepatic arterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) and programmed death receptors-1 (PD-1) inhibitors (TACE+TKIs+PD-1 antibody) in the treatment of moderate advanced unresectable hepatocellular carcinoma (HCC).Methods The clinical data of 65 patients with moderate advanced unresectable hepatocellular carcinoma admitted to the Affiliated Hospital of North Sichuan Medical College from January 2020 to January 2022 were analyzed retrospectively.65 patients were treated with TACE+TKIs+PD-1 antibody.The observation indexes were tumor response,objective response rate (ORR),disease control rate (DCR),total survival time,progression free survival time,conversion operation rate and adverse drug reaction.Results The ORR of 65 patients with hepatocellular carcinoma was 49.2% (32/65),and the DCR was 89.2% (58/65).Among them,there were 2 patients with complete remission(CR),30 patients with partial remission(PR),26 patients with stable disease(SD),and 7 patients with progression disease(PD).Among 65 patients with hepatocellular carcinoma,18 patients were transformed into resectable hepatocell-ular carcinoma and underwent RO surgery.The conversion rate was 27.6% (18/65).65 patients were followed up for 3 to 22.4 months,The median follow-up time was 16.5 months.The median overall survival time and median disease progression free survival time of 65 patients were 14.5 months (95% CI:12.3~16.6 months) and 8.8 months (95% CI:6.9~10.6 months),respectively.After treatment,65 patients all had post embolism syndrome (abdominal pain,fever,nausea,vomiting and other symptoms),and some patients had transient abnormal liver function.Adverse drug reactions below grade 3 recovered within a few days.Some patients were associated with multiple adverse drug reactions.1 patient (1.5%)  stopped using TACE because of stubborn vomiting,and 5 patients (7.6%) stopped using Lenvatinib because of severe liver function damage during treatment,2 patients (3%) stopped using Camrelizumab because of severe reactive capillary hyperplasia,one patient (1.5%) stopped using Tislelizumab because of severe hypothyroidism,one patient (1.5%) stopped the treatment of Lenvatinib and Sintilimab due to severe gastrointestinal bleeding.The adverse drug reactions of grade 3~4 occurred in other patients were alleviated after drug reduction,symptomatic treatment and hormone treatment.Conclusion TACE+TKIs+PD-1 antibody can obtain reliable clinical efficacy and anti-tumor activity in the treatment of moderate advanced unresectable hepatocellular carcinoma.

Key words: hepatocellular carcinoma, transcatheter arterial chemoembolization, tyrosine kinase inhibitor, programmed death receptor-1 inhibitor, clinical efficacy