靶向免疫治疗联合经肝动脉灌注化疗治疗不可切除肝细胞癌的临床效果及转化治疗的影响因素  

Clinical Effect of Targeted Immunotherapy Combined with Hepatic Arterial Infusion Chemotherapy in the Treatment of Unresectable Hepatocellular Carcinoma and the Influencing Factors of Transformation Therapy

作　　者：康志龙 周益民[2] 宋燕州 张昆 苏一男 魏文平 赵新 李志伟 KANG Zhilong;ZHOU Yimin;SONG Yanzhou;ZHANG Kun;SU Yinan;WEI Wenping;ZHAO Xin;LI Zhiwei(Department of Hepatobiliary Surgery,Shenzhen Third People's Hospital,Shenzhen 518000,China;不详)

机构地区：[1]深圳市第三人民医院肝胆外科,广东深圳518000 [2]邢台医学高等专科学校附属第二医院肿瘤外科,河北邢台054000

出　　处：《中国医学创新》2025年第1期47-51,共5页Medical Innovation of China

摘　　要：目的:探讨不可切除肝细胞癌(uHCC)患者行靶向免疫治疗联合经肝动脉灌注化疗(HAIC)的临床效果及转化治疗的影响因素。方法:选取2022年6月—2023年5月深圳市第三人民医院收治的uHCC患者共计67例。所有患者均接受靶向免疫治疗联合HAIC,并记录临床疗效,统计转化治疗成功情况,以单因素与多因素logistic回归分析明确转化治疗失败的影响因素。结果:67例uHCC患者中,完全缓解(CR)0例(0),部分缓解(PR)34例(50.75%),疾病稳定(SD)23例(34.33%),疾病进展(PD)10例(14.93%),客观缓解率(ORR)为50.75%(34/67),疾病控制率(DCR)为85.07%(57/67)。67例uHCC患者的转化治疗成功率为40.30%(27/67)。未转化组多发肿瘤、双叶肿瘤、肿瘤低分化、合并肝硬化、总胆红素(TBIL)水平>17.1μmol/L的占比均较转化组高,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,多发肿瘤(OR=2.930)、双叶肿瘤(OR=7.752)、肿瘤低分化(OR=5.603)、合并肝硬化(OR=7.890)、TBIL水平>17.1μmol/L(OR=5.261)是影响uHCC转化治疗失败的独立危险因素(P<0.05)。结论:uHCC患者行靶向免疫治疗联合HAIC的效果确切,但肿瘤数量、肿瘤位置、肿瘤低分化、合并肝硬化、TBIL水平均会影响转化治疗成功率,需要重点关注。Objective:To explore the clinical effect of targeted immunotherapy combined with hepatic arterial infusion chemotherapy(HAIC)in patients with unresectable hepatocellular carcinoma(uHCC)and the influencing factors of transformation therapy.Method:A total of 67 patients with uHCC admitted to the Shenzhen Third People's Hospital from June 2022 to May 2023 were selected.All patients received targeted immunotherapy combined with HAIC,the clinical efficacy was recorded,and the success of transformation therapy was counted,and the influencing factors of transformation therapy failure were clarified by univariate and multivariate logistic regression analysis.Result:Among 67 patients with uHCC,there were 0 case(0)of complete response(CR),34 cases(50.75%)of partial response(PR),23 cases(34.33%)of stable disease(SD),10 cases(14.93%)of progressive disease(PD),and the objective response rate(ORR)was 50.75%(34/67),the disease control rate(DCR)was 85.07%(57/67).The success rate of transformation therapy of 67 patients with uHCC was 40.30%(27/67).The proportion of multiple tumors,bilobal tumors,poorly differentiated tumor,concurrent cirrhosis and total bilirubin(TBIL)level>17.1μmol/L in the non-transformed group were higher than those in the transformed group,the differences were statistically significant(P<0.05).The results of multivariate logistic analysis showed that multiple tumors(OR=2.930),bilateral tumors(OR=7.752),poorly differentiated tumors(OR=5.603),concurrent cirrhosis(OR=7.890)and TBIL levels>17.1μmol/L(OR=5.261)were independent risk factors affecting the failure of uHCC transformation therapy(P<0.05).Conclusion:The efficacy of targeted immunotherapy combined with HAIC in uHCC patients is certain,but the number of tumors,tumor location,poorly differentiated tumor,concurrent cirrhosis and TBIL level will all affect the success rate of transformation therapy,which needs to be paid attention to.

关 键 词：不可切除肝细胞癌 靶向免疫治疗 经动脉灌注化疗 转化治疗 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]