The effect of targeted immunotherapy on re bleeding after endoscopic treatment in patients with advanced liver cancer and esophageal and gastric variceal bleeding
Objective To investigate whether discontinuation of previous targeted immunotherapy increases the risk of rebleeding in patients with advanced liver cancer complicated with esophageal and gastric variceal bleeding after endoscopic treatment.Methods A retrospective cohort study was conducted to include advanced liver cancer patients who were diagnosed with esophageal and gastric variceal bleeding through endoscopic examination and treated under endoscopy at Zhongshan Hospital,Fudan University from March 1,2020 to March 1,2022,due to upper gastrointestinal bleeding.We collected clinical data from patients and divided them into targeted immunotherapy group and non targeted immunotherapy group based on whether they received targeted immunotherapy before bleeding;Follow up observation was conducted for 6 months to evaluate the patient's re bleeding and survival status.Results A total of 55 patients were included,of which 24 had previously received targeted immunotherapy and 31 had not received targeted immunotherapy.There was no significant difference between the two groups in gender distribution,etiology,hypertension and diabetes(all P＞0.05).The age of the target immunotherapy group was younger than that of the non target immunotherapy group,and the level of fibrinogen was higher than that of the non target immunotherapy group,with statistical significance(P=0.002,0.017).There was no statistically significant difference in the 6-month re bleeding rate(20.83％vs 22.58％,P=0.269)and 6-month mortality rate(45.83％vs 29.03％,P=0.199)between the targeted and non targeted groups of patients.Further Cox regression multivariate analysis revealed that Child-pugh grading was an independent risk factor for 6-month survival in patients with advanced liver cancer with esophageal and gastric varices(HR=2.64,P=0.009).Conclusions Targeted immunotherapy does not increase the rate of rebleeding in patients with advanced unresectable liver cancer after endoscopic treatment of esophageal and gastric varices.Child-pugh grading is a factor that affects the 6-month survival of advanced liver cancer patients after bleeding,and the poorer the liver function,the shorter the survival period.
Liver neoplasmsImmunotherapyEsophageal and gastric varicesEndoscopyHemorrhage
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