肝胆胰外科杂志2025，Vol.37Issue(10)：682-691,10.DOI:10.11952/j.issn.1007-1954.2025.10.005
TACE联合靶免药物序贯肝切除术对中晚期肝细胞癌的疗效及影响因素分析
Efficacy and prognostic factors of transcatheter arterial chemoembolization combined with targeted therapy and immunotherapy sequential hepatectomy for unresectable hepatocellular carcinoma
摘要
Abstract
Objective To investigate the efficacy and prognostic factors of transcatheter arterial chemoembolization(TACE)combined with targeted therappy and immunotherapy sequential hepatectomy in the treatment of unresectable hepatocellular carcinoma(HCC),and to analyze the factors for overall survival(OS)and progression-free survival(PFS).Methods This project retrospectively collected the clinical data of 45 patients with unresectable HCC who were admitted to the First Affiliated Hospital of Army Medical University from January 2021 to December 2024,and successfully underwent sequential liver resection after TACE combined with targeted and immune drug conversion.The clinical characteristics,tumor response after conversion therapy.Postoperative pathological remission,adverse reactions,postoperative tumor progression and patient survival were summarized.The efficacy and influencing factors of TACE combined with targeted therapy and immunotherapy drugs followed by sequential liver resection in the treatment of unresectable HCC were analyzed.Results All the 45 patients were followed up,with a median follow-up time of 17.7 months,till to December 31,2024,3 patients died and 42 survived.The OS was not obtained,and the PFS was(32.2±14.0)months.The 1-,2-,and 3-year OS rates were 95.0％,90.7％,and 90.7％,respectively.The 1-,2-,and 3-year PFS rates were 53.4％,50.3％,and 33.5％,respectively.After liver resection,20 patients had tumor progression and 25 remained tumor-free.Univariate analysis showed that low tumor differentiation and positive MVI were independent risk factors affecting the PFS of unresectable HCC patients(P=0.016,P=0.048).Multivariate analysis showed that only low tumor differentiation was an independent risk factor affecting the PFS of unresectable HCC patients(P=0.024).The overall incidence of adverse reactions was 100.0％,and the incidence of grade 3-4 adverse reactions was 28.9％.All adverse reactions were safe and controllable,and improved after symptomatic treatment.Conclusion TACE combined with targeted therapy and immunotherapy sequential hepatectomy is a safe and effective comprehensive treatment for unresectabed HCC,which provides a new treatment strategy for unresectable HCC patients.关键词
肝细胞癌/肝动脉化疗栓塞/靶向治疗/免疫治疗/总生存期/无疾病进展生存期Key words
hepatocellular carcinoma/transcatheter arterial chemoembolization/targeted therapy/immunotherapy/overall survival/progression-free survival分类
临床医学引用本文复制引用
蒋家云,张辉,赖洁娟,欧晏娇,王小军,马宽生,张雷达..TACE联合靶免药物序贯肝切除术对中晚期肝细胞癌的疗效及影响因素分析[J].肝胆胰外科杂志,2025,37(10):682-691,10.基金项目
重庆市博士"直通车"科研项目(CSTB2022BSXM-JCX0004) （CSTB2022BSXM-JCX0004）
重庆市自然科学基金面上项目(CSTB2023NSCQ-MSX0906). （CSTB2023NSCQ-MSX0906）
