| 陶英奇.基于靶免联合TACE的转化治疗后肝细胞癌手术切除的临床结局与病理缓解分析[J].安徽医药,待发表. |
| 基于靶免联合TACE的转化治疗后肝细胞癌手术切除的临床结局与病理缓解分析 |
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| 投稿时间：2026-09-10 录用日期：2026-11-07 |
| DOI： |
| 中文关键词: 肝细胞癌 经动脉化疗栓塞 靶向联合免疫 转化治疗 病理缓解 无复发生存 预后 |
| 英文关键词: |
| 基金项目:河北省医学科学研究课题计划资助(编号:20251304) |
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| 中文摘要: |
| 目的:比较单纯TACE与仑伐替尼+信迪利单抗联合TACE三联转化治疗用于不可切除BCLCB/C期肝细胞癌(HCC)的转化疗效、病理缓解及安全性。方法:纳入2021年1月-2024年6月邢台市人民医院126例初诊不可切除HCC患者,经1:1倾向性评分匹配分为观察组(三联方案,n=63)、对照组(单纯TACE,n=63),转化达标后行根治性肝切除术。主要终点为手术转化率、术后病理缓解率。次要终点包含肿瘤标志物、围手术期指标、术后无复发生存(RFS)。评估转化期不良事件。多因素Logistic回归筛选术后复发独立危险因素。结果:两组基线资料均衡可比(P>0.05)。观察组手术转化率77.78%,高于对照组57.14%(χ²=5.833,P=0.016)。观察组病理完全缓解(pCR)30.61%、病理部分缓解(pPR)48.98%,均显著优于对照组(Fisher精确P值分别为0.034、0.029)。转化后两组AFP、PIVKA-II均下降,观察组降低幅度更显著(P<0.001)。两组手术相关指标无统计学差异(P>0.05)。术后6、12个月观察组RFS率83.67%、67.35%,显著高于对照组66.67%、47.22%(P<0.05)。两组转化期不良反应总发生率无差异(22.22%vs17.46%,P=0.539),无Ⅲ～Ⅳ级重度不良事件。多因素回归显示:三联转化、pCR为复发独立保护性预测因素,肿瘤最大径≥8cm为独立危险因素(P<0.05)。结论:相较于单纯TACE,仑伐替尼联合信迪利单抗+TACE三联转化可提升不可切除HCC手术转化与病理缓解水平,有效降低肿瘤负荷标志物,延长术后中远期无复发生存。联合方案不良反应可控,未显著增加围手术期手术难度或出血风险,适用于肝功能储备良好的BCLCB/C期患者,可作为优选转化策略。 |
| 英文摘要: |
| Objective: To compare the conversion efficacy, pathological response and safety between transarterial chemoembolization (TACE) monotherapy and triple conversion therapy (lenvatinib plus sintilimab combined with TACE) for unresectable BCLC B/C stage hepatocellular carcinoma (HCC). Methods: A total of 126 patients with newly diagnosed unresectable HCC admitted to our hospital from January 2021 to June 2024 were enrolled. Patients were divided into an observation group (triple regimen, n=63) and a control group (TACE monotherapy, n=63) via 1:1 propensity score matching. Radical hepatectomy was performed once conversion criteria were met. The primary endpoints were surgical conversion rate and postoperative pathological response rate. Secondary endpoints included tumor markers, perioperative indicators and postoperative recurrence-free survival (RFS). Adverse events during conversion therapy were evaluated. Multivariate Logistic regression was adopted to screen independent risk factors for postoperative recurrence. Results: Baseline data were well balanced between the two groups (P>0.05). The surgical conversion rate of the observation group was 77.78%, which was higher than 57.14% of the control group (χ²=5.833, P=0.016). The rates of pathological complete response (pCR) and pathological partial response (pPR) in the observation group were 30.61% and 48.98%, respectively, both significantly superior to those in the control group (Fisher’s exact P=0.034 and 0.029, respectively). Serum AFP and PIVKA-II levels decreased in both groups after conversion therapy, with a more prominent reduction observed in the observation group (P<0.001). No statistically significant differences were found in surgery-related indicators between the two groups (P>0.05). The 6- and 12-month postoperative RFS rates of the observation group were 83.67% and 67.35%, markedly higher than 66.67% and 47.22% of the control group (P<0.05). The overall incidence of adverse events during conversion therapy was comparable between the two groups (22.22% vs 17.46%, P=0.539), and no grade III–IV severe adverse events occurred. Multivariate regression analysis demonstrated that triple conversion therapy and pCR were independent protective predictors against recurrence, while maximum tumor diameter ≥8 cm was an independent risk factor (P<0.05). Conclusion: Compared with TACE monotherapy, triple conversion therapy with lenvatinib plus sintilimab combined with TACE can improve surgical conversion rates and pathological response depth in patients with unresectable HCC, effectively reduce tumor burden markers, and prolong medium- and long-term postoperative recurrence-free survival. The combination regimen presents manageable adverse events without significantly increasing perioperative surgical difficulty or hemorrhage risk. It is applicable to patients with BCLC B/C stage HCC and preserved liver function reserve, and can serve as a preferred conversion strategy. |
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