解放军医学杂志2026，Vol.51Issue(4)：531-541,11.DOI:10.11855/j.issn.0577-7402.1981.2026.0314
氩氦刀冷冻消融与经动脉化疗栓塞联合仑伐替尼治疗不可切除肝细胞癌的疗效与安全性比较
Comparison of efficacy and safety between argon-helium cryoablation combined with lenvatinib and transarterial chemoembolization combined with lenvatinib for unresectable hepatocellular carcinoma
摘要
Abstract
Objective To compare the efficacy and safety of argon-helium cryoablation(CRYO)combined with lenvatinib(LEN)and transarterial chemoembolization(TACE)combined with LEN in the treatment of unresectable hepatocellular carcinoma(uHCC).Methods This was a retrospective cohort study.A total of 234 patients with uHCC admitted to the Hepatology Medical Center of Chinese PLA General Hospital from May 2020 to March 2023 were enrolled,including 107 patients treated with TACE+LEN(TACE+LEN group)and 127 patients treated with CRYO+LEN(CRYO+LEN group).A 1:1 propensity score matching(PSM)was used to balance baseline characteristics,and 192 patients were finally enrolled.Study endpoints included overall survival(OS),progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR),and adverse events(AEs).Survival differences were analyzed using Kaplan-Meier method,and independent prognostic factors were screened using Cox regression and LASSO regression analyses.Results After PSM,baseline characteristics were well balanced between the two groups(P>0.05).Of the 192 patients,178(92.7%)were male,182(94.8%)had liver cirrhosis,149(77.6%)were Child-Pugh class A,and 130(67.7%)were at Barcelona Clinic Liver Cancer(BCLC)stage C.No significant differences were observed between CRYO+LEN and TACE+LEN groups in median OS(24.2 months vs.22.0 months,HR=1.10,P=0.635),median PFS(8.7 months vs.11.9 months,HR=0.89,P=0.477),ORR(53.1%vs.53.1%,P=1.000),or DCR(78.1%vs.86.5%,P=0.186).Multivariate Cox regression analysis identified hepatitis B virus(HBV)infection(HR=0.231,P=0.014),Child-Pugh class(HR=1.757,P=0.017),maximum tumor diameter(HR=1.908,P=0.003),and subsequent anti-programmed cell death protein-1(PD-1)therapy(HR=0.652,P=0.045)as independent factors influencing OS.CRYO+LEN group had higher incidences of pleural effusion(6.2%vs.0%,P=0.038)and skin frostbite(8.3%vs.0%,P=0.011),while TACE+LEN group was more prone to abdominal pain(7.3%vs.0%,P=0.021)and non-infectious fever(24%vs.5.2%,P=0.001).There were no significant differences in other AEs between the two groups(P>0.05).Conclusions CRYO combined with LEN demonstrates similar clinical benefits and manageable safety profiles to TACE combined with LEN in the treatment of uHCC,providing an effective alternative therapeutic option for patients unsuitable for TACE.关键词
不可切除肝细胞癌/经肝动脉化疗栓塞/冷冻消融/仑伐替尼Key words
unresectable hepatocellular carcinoma/transarterial chemoembolization/cryoablation/lenvatinib分类
医药卫生引用本文复制引用
王迪,常秀娟,宫嫚,张伟,张慧鑫,孔慧芳,黄加干,高旭东,曾珍..氩氦刀冷冻消融与经动脉化疗栓塞联合仑伐替尼治疗不可切除肝细胞癌的疗效与安全性比较[J].解放军医学杂志,2026,51(4):531-541,11.基金项目
This work was supported by the National Natural Science Foundation of China(82570716),the National Science and Technology Major Project(2025ZD01906003),the National Health Commission Research Project(WKZX2023CX020011),and the Natural Science Foundation of Beijing(7252131) 国家自然科学基金(82570716) （82570716）
国家科技部重大专项(2025ZD01906003) （2025ZD01906003）
国家卫生健康委研究项目(WKZX2023CX020011) （WKZX2023CX020011）
北京市自然科学基金(7252131) （7252131）
