肝细胞癌中免疫检查点抑制剂治疗的抵抗机制:现状与挑战  

Mechanisms of resistance to immune checkpoint inhibitor therapy in hepatocellular carcinoma:current status and challenges

作　　者：刘鹏辉 李娜[1] 董艳 郭凌云[2] 毛杰[2] Liu Penghui;Li Na;Dong Yan;Guo Lingyun;Mao Jie(Second Clinical Medical College,Lanzhou University,Lanzhou 730030,China;Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二临床医学院,兰州730030 [2]兰州大学第二医院,兰州730030

出　　处：《中华肝胆外科杂志》2025年第2期141-146,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：甘肃省自然科学基金(24JRRA334)。

摘　　要：本综述立足于免疫检查点抑制剂(ICIs)在肝细胞癌治疗中的研究进展及面临的挑战。ICIs阻断PD-1/PD-L1和CTLA-4通路,重启机体的抗肿瘤免疫反应,为晚期肝细胞癌患者提供新型治疗方案。然而,ICIs的应用仍受到原发性与获得性耐药、免疫相关不良事件及肿瘤微环境抑制等因素的限制。本文深入分析了这些影响ICIs疗效的关键机制,并提出了其与靶向治疗、化疗和放疗等疗法的联合应用、调控肿瘤微环境以及开发生物标志物等优化治疗的策略。未来研究应重点关注个体化治疗,结合患者的分子与免疫特征,以提高ICIs疗法的精准性和疗效,为肝细胞癌患者提供更有效的治疗方案。This review is based on the research progress and challenges of immune checkpoint inhibitors(ICIs)in the treatment of hepatocellular carcinoma(HCC).ICIs block the PD-1/PD-L1 and CTLA-4 pathways;thereby reactivate the body’s anti-tumor immune response,providing a new therapeutic option for patients with advanced HCC.However,the effect of ICIs is still compromised by factors such as primary and acquired resistance,immune-related adverse events and tumor microenvironment inhibition.This reveiw deeply analyzes these key mechanisms that affect the efficacy of ICIs,and proposes strategies to optimize the treatment,including combination with targeted therapy,chemotherapy and radiotherapy,modulation of tumor microenvironment,and the development of novel biomarkers.Future research should focus on personalized treatment that integrates the molecular and immunological characteristics of patients to enhance the precision and efficacy of ICIs therapy for patients with HCC.

关 键 词：癌 肝细胞 免疫治疗 免疫检查点抑制剂 抵抗机制 

分 类 号：R73[医药卫生—肿瘤]