TACE联合HAIC加靶免“四联”疗法对中晚期肝细胞癌的疗效分析  

Efficacy of TACE combined with HAIC plus targeted-immune quadruple therapy for advanced hepatocellular carcinoma

作　　者：王远鹏 张国林 康壮壮 刘中 孙万亮 周磊 顾海涛 褚亮 WANG Yuanpeng;ZHANG Guolin;KANG Zhuangzhuang;LIU Zhong;SUN Wanliang;ZHOU Lei;GU Haitao;CHU Liang(Depatment of General Surgery,the Second Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui 233040,China;Depatment of Hepatobiliary Surgery,the First Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui 233040,China)

机构地区：[1]蚌埠医科大学第二附属医院普通外科,安徽蚌埠233040 [2]蚌埠医科大学第一附属医院肝胆外科,安徽蚌埠233040

出　　处：《肝胆胰外科杂志》2025年第3期179-184,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：安徽省卫生健康科研青年项目(AHWJ2023A30187)。

摘　　要：目的探讨肝动脉化疗栓塞(TACE)联合肝动脉灌注化疗(HAIC)、靶向药物和PD-1免疫抑制剂“四联”疗法对中晚期肝细胞癌(HCC)的安全性及临床疗效。方法回顾性选取2022年4月至2023年11月蚌埠医科大学第二附属医院普外科收治的88例中晚期HCC患者,其中对照组(n=34)接受“三联”疗法,观察组(n=54)接受“四联”疗法,比较两组的客观缓解率、疾病控制率、转化成功率、中位总生存时间(mOS)、中位无进展生存时间(mPFS)、不良事件及并发症、术后焦虑发生情况。结果以mRECIST标准评估,观察组客观缓解率(19/54,35.19%)、疾病控制率(33/54,61.11%)均高于对照组[(5/34,14.71%),(11/34,32.35%)],差异具有统计学意义(χ^(2)=4.412,P<0.05;χ^(2)=6.902,P<0.05)。观察组手术可切除的转化成功率(17/54,31.48%)高于对照组(3/34,8.82%),差异具有统计学意义(χ^(2)=6.099,P<0.05)。观察组mOS为17.4个月(95%CI 16.0-18.8)、mPFS为14.6个月(95%CI 12.7-16.5)均高于对照组[分别为12.4个月(95%CI 10.4-14.4),9.3个月(95%CI 8.8-9.7)],差异具有统计学意义(P<0.001)。两组患者介入治疗后并发症发生率差异并无统计学意义(P>0.05),两组最常见的并发症是γ-谷氨酰转移酶升高,其次是腹痛、恶心。观察组患者术区疼痛及焦虑的发生率较对照组高,差异具有统计学意义(χ^(2)=11.74,P<0.05;χ^(2)=4.452,P<0.05)。结论TACE联合HAIC、仑伐替尼及信迪利单抗“四联”疗法在不增加围术期不良事件及并发症的前提下,提高了中晚期HCC患者的客观缓解率、疾病控制率及转化成功率,延长了mOS和mPFS。Objective To investigate the safety and clinical effi cacy of“quadruple therapy”,transcatheter arterial chemoembolization(TACE)combined with hepatic arterial infusion chemotherapy(HAIC),targeted drugs and PD-1 immunosuppressive for advanced hepatocellular carcinoma(HCC).Methods A total of 88 patients with advanced HCC,who admitted to the Second Affi liated Hospital of Bengbu Medical University between Apr.2022 and Nov.2023,were retrospectively selected for this study.Patients in the control group(n=34)received triple therapy,while patients in the observational group(n=54)received quadruple therapy.The objective response rate,disease control rate,success rate of conversion to surgical resection,median overall survival time(mOS),median progression-free survival time(mPFS),adverse events and complications,and postoperative anxiety were compared between the two groups.Results According to the mRECIST criteria,the objective response rate(19/54,35.19%)and disease control rate(33/54,61.11%)in the observational group were significantly higher than those in the control group(5/34,14.71%and 11/34,32.35%,respectively),the diff erences were statistically significant(χ^(2)=4.412,P<0.05;χ^(2)=6.902,P<0.05).The success rate of conversion to surgical resection in the observational group(17/54,31.48%)was also higher than that in the control group(3/34,8.82%),and the diff erence was statistically significant(χ^(2)=6.099,P<0.05).The mOS of 17.4 months(95%CI 16.0 to 18.8)and mPFS of 14.6 months(95%CI 12.7 to 16.5)in the observational group were significantly longer than those in the control group[12.4 months(95%CI 10.4 to 14.4),9.3 months(95%CI 8.8 to 9.7)],and the diff erences were statistically significant(P<0.001).There was no significant diff erence in terms of complication incidence rate between the two groups after interventional therapy(P>0.05).The most common complication in both groups was the increase ofγ-glutamyl transferase,followed by abdominal pain and nausea.The incidence of pain and anxiety in the observation

关 键 词：中晚期肝细胞癌 肝动脉化疗栓塞 肝动脉灌注化疗 仑伐替尼 信迪利单抗 

分 类 号：R735.7[医药卫生—肿瘤]