Abstract: Objective  To observe the clinical efficacy and safety of apatinib in the treatment of advanced malignant tumors and to analyze the prognostic indicators affecting the survival of patients. MethodsA total of 100 patients with advanced malignant tumors who were treated with apatinib at Jinan Central Hospital Affiliated to Shandong University from February 2015 to July 2018 were enrolled and their data were analyzed retrospectively. The clinical efficacy was  evaluated and the related adverse reactions were recorded. Single and multiple factor analyses were performed by Cox regression model. The predictive factors of progressionfree survival (PFS) and overall survival (OS) were analyzed. Results  One-hundred patients with advanced malignant tumors who were treated with secondline and above treatment were collected. All patients were assessable for response, no complete response was observed, 22 patients (22%) achieved   partial remission, 58 patients (58%) in  stable disease, and 20 patients (20%) appeared progressive disease. The objective response rate was 22% (22/100), the disease control rate was 80% (80/100), the median PFS was 3.6 months (95%CI: 2.74.5 months), and the median OS was 7.0 months (95%CI: 4.79.3 months). Univariate analysis showed that Eastern Cooperative Oncology Group (ECOG) score (HR=0.340, 95%CI: 0.2110.546, P＜0.001), tumor  primary site  (HR=1.757, 95%CI: 1.0532.932, P=0.031), neutrophil to lymphocyte ratio (NLR) (HR=0.389, 95%CI: 0.2270.666, P=0.001), hemoglobin (HR=1.696, 95%CI: 1.0232.813, P=0.041) and proteinuria (HR=1.790, 95%CI: 1.1053.155, P=0.044)  were related to PFS; age (HR=2.082, 95%CI: 1.3203.285, P=0.002), ECOG score (HR=0.206, 95%CI: 0.1230.344, P＜0.001), tumor primary site (HR=1.784, 95%CI: 1.0772.954, P=0.025), NLR (HR=0.410, 95%CI: 0.2380.704, P=0.001), hemoglobin (HR=1.958, 95%CI: 1.1753.264, P=0.010) and albumin (HR=0.467, 95%CI: 0.2770.787, P=0.004) were related with OS. Multivariate analysis showed that PFS was related to ECOG score (HR=0.254, 95%CI: 0.1230.523, P＜0.001) and NLR (HR=0.378, 95%CI: 0.1610.888, P=0.026), and OS was related to ECOG score (HR=0.147, 95%CI: 0.0670.326, P＜0.001), NLR (HR=0.327, 95%CI: 0.1400.765, P=0.010) and hemoglobin (HR=1.975, 95%CI: 1.1013.543, P=0.022). In term of safety, the most common adverse events among 100 cases of treated patients with advanced malignant tumors  were hypertension (53, 53%), anorexia (51, 51%), fatigue (51, 51%) and anemia (50, 50%), among which the most common ones of grade 3 and 4 were hypertension (10, 10%), thrombocytopenia (8, 8%), leukopenia (7, 7%) and handfoot syndrome (6, 6%). Conclusion  Apatinib has certain clinical efficacy and manageable adverse events in the treatment of advanced malignant tumors at and above secondline treatment. ECOG score and NLR are independent predictors of PFS and OS in patients with advanced malignant tumors treated with apatinib.

Key words: Neoplasms, Treatment outcome, Drug-related side effects and adverse reactions, Apatinib, Prognosis