中国普通外科杂志2025，Vol.34Issue(7)：1371-1381,11.DOI:10.7659/j.issn.1005-6947.250082
局部治疗联合系统治疗对CNLC Ⅲb期肝细胞癌患者的疗效分析
Efficacy of combined local and systemic therapy in CNLC stage Ⅲb hepatocellular carcinoma
摘要
Abstract
Background and Aims:CNLC stage IIIb hepatocellular carcinoma(HCC)is often accompanied by extrahepatic metastases and carries a poor prognosis.The optimal treatment strategy for these patients remains controversial,and the role of local therapy lacks robust evidence.This study aimed to compare overall survival(OS)between patients receiving combined local and systemic therapy versus systemic therapy alone,and to assess the prognostic impact of oligometastatic status and the cumulative duration of no evidence of disease(NED). Methods:A retrospective analysis was conducted on 76 CNLC stage IIIb HCC patients treated at Xiangya Hospital from January 2017 to December 2023.Forty patients received systemic therapy plus local therapy(local therapy group),and 36 received systemic therapy alone(no local therapy group).OS was compared between the two groups.Subgroup analyses were performed for oligometastatic and non-oligometastatic patients to evaluate the benefit of local therapy.In the local therapy group,the correlation between cumulative NED duration and OS was also examined. Results:The 1-,2-,3-,and 5-year OS rates were 89.0%vs.66.7%,64.3%vs.25.6%,35.3%vs.8.7%,and 8.3%vs.0.0%for the local therapy and no local therapy groups,respectively,with a statistically significant difference(P=0.003).Among oligometastatic patients,the local therapy group had significantly better OS than the no local therapy group(P=0.008),whereas no significant difference was observed in non-oligometastatic patients(P>0.05).Multivariate analysis identified oligometastases as an independent prognostic factor(HR=2.213,P=0.045).In the local therapy group,cumulative NED duration was strongly correlated with OS(r=0.851,P<0.001).Local therapy was well tolerated,with no treatment-related deaths observed. Conclusion:For CNLC stage IIIb HCC patients with well-controlled intrahepatic disease,local therapy can significantly prolong survival,particularly in those with oligometastases.Achieving and maintaining NED may represent an important therapeutic goal in this patient population.关键词
癌,肝细胞/肝外转移/局部治疗Key words
Carcinoma,Hepatocellular/Extrahepatic Metastasis/Local Therapy分类
医药卫生引用本文复制引用
杨瀚睿,范钦桥,肖亮,谢育霖,卢诗琪,袁洪涛,周乐杜..局部治疗联合系统治疗对CNLC Ⅲb期肝细胞癌患者的疗效分析[J].中国普通外科杂志,2025,34(7):1371-1381,11.基金项目
国家自然科学基金资助项目(81771932). （81771932）
