Hepatectomy Combined With Camrelizumab and Apatinib in CNLC Stage IIIb HCC

Prior treatment

• Have used or are currently using other immunosuppressive or chemotherapy drugs for HCC (including but not limited to atezolizumab, nivolumab, pembrolizumab, tislelizumab, toripalimab, sintilimab, camrelizumab, S-1, etc.);
• Patients who have received TACE, radiotherapy or systemic therapy within the past 6 months;
• Arterial or venous thrombosis, such as cerebrovascular accident (transient ischemic attack, cerebral hemorrhage, cerebral infarction, etc.), deep venous thrombosis and pulmonary infarction, etc., 6 months before enrollment;
• Autoimmune diseases in active stage or previous autoimmune diseases (such as autoimmune hepatitis, interstitial pneumonia, uveitis, enteritis, hypophysitis, vasculitis, nephritis, hyperthyroidism, etc.);
• Were using immunosuppressant or hormone therapy 2 weeks before enrollment;
• Grade 1 CTCAE was not recovered after less than 5 drug half-lives with the last use of molecular targeted therapy or due to adverse events caused by previous therapy;

Other illness

• Have a history or concurrence of other malignancies, except cured basal cell carcinoma of the skin and carcinoma in situ of the cervix;
• The presence of congenital or acquired immune deficiency diseases (such as HIV positive);
• Known severe allergic reactions to PD-1 mab;
• Patients with hemorrhagic diseases (including but not limited to moderate/severe esophagogastric varices, gastrointestinal bleeding, hemorrhagic gastric ulcer, hemoptysis \> 2.5 ml per day) within 3 months of enrollment;For cases with positive occult blood in stool, occult blood should be reexamined, and gastroenteroscopy should be performed if necessary);
• Those who have a history of alcohol or psychotropic drug abuse and cannot get rid of it or have mental disorders;
• Hypertension beyond drug control (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg);
• Uncontrolled heart disease or symptoms (including but not limited to grade II or higher cardiac function, unstable angina, myocardial infarction in the past 1 year, supraventricular or ventricular arrhythmias requiring treatment or intervention);
• Hereditary or acquired blood diseases (such as hemophilia, thrombocytopenia, coagulation disorders, etc.);

Lab values

• Within 7 days of enrollment, body temperature of unknown etiology ≥ 38.5℃ or white blood cell count \> 15 x 109/L;
• Abnormal coagulation function (INR \> 2.0, PT \> 16 s), bleeding tendency or need thrombolytic therapy or anticoagulant therapy (but prophylactic use of low-dose aspirin or low-molecular weight heparin is permitted);

Other

• Breast-feeding women;
• Complicated with hepatic encephalopathy or brain metastasis;
• Urine protein ≥ ++ and 24-hour urine protein ≥ 1.0g in routine urine tests.

• Age ≥18
• CNLC stage IIIb HCC with extrahepatic metastasis (such as lymph node, lung, bone metastasis, but not brain metastasis) diagnosed by clinical imaging, and at least one measurable metastasis can be used as RECIST V1.1 to observe the objective efficacy of "targeted + immune" therapy on target lesions;
• Local tumors of the liver are expected to be radically resected;
• Liver function Child-Pugh grade A;
• ICG R15 \< 10%;
• ECOG PS 0 or 1 score;
• Estimated survival time ≥6 months;
• Hematological indexes should meet the following conditions: hemoglobin ≥90 g/L; Neutrophil absolute count ≥1.5×109/L; Platelet ≥80×109/L; Total bilirubin ≤1.5×ULN; ALT 3 x ULN or less;AST 3 x ULN or less; Alkaline phosphatase (AKP) ≤2.5×ULN; Serum albumin ≥28 g/L; Serum creatinine ≤1.5×ULN;
• The patient is unwilling to receive TACE or radiotherapy;
• For women of childbearing age, contraceptive measures (such as intrauterine devices, contraceptive tablets or condoms) should be used during the clinical trial until 3 months after the clinical trial ends; Serum or urine HCG test was negative for women of childbearing age within 72 hours prior to study enrollment. Effective contraception should be used during the study period and for three months after the end of the study for male patients with fertile partners.