TACE术联合靶向和免疫治疗原发性肝癌患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.04.029

摘要/Abstract

摘要： 目的探讨靶向和免疫治疗联合肝动脉化疗栓塞术(TACE)治疗原发性肝癌(PLC)患者的疗效。方法 2021年5月～2023年4月我院收治的PLC患者100例,被随机分为对照组50例和观察组50例,分别给予TACE治疗,或在TACE治疗的基础上,给予阿帕替尼或仑伐替尼联合卡瑞利珠单抗、替雷利珠单抗、特瑞普利单抗、帕博利珠单抗、信迪利或贝伐珠单抗治疗。使用流式细胞仪检测外周血CD4⁺和CD8⁺细胞百分比,采用放射免疫法检测血清甲胎蛋白(AFP)水平,采用ELISA法检测血清巨噬细胞转移抑制因子MIF)和血管内皮生长因子(VEGF)水平。随访1年。结果在治疗3个月末,观察组客观缓解率为62.0%,显著高于对照组的42.0%(P＜0.05;治疗后,观察组外周血CD4⁺百分比和CD4⁺/CD8⁺细胞比值分别为(46.8±4.6)%和(1.8±0.3),均显著高于对照组【分别为(37.3±4.2)%和(1.3±0.3),P＜0.05】,而CD8⁺细胞百分比为(25.1±2.4)%,显著低于对照组【(28.5±2.5)%,P＜0.05】;观察组血清AFP、MIF和VEGF水平分别为(110.2±27.5)μg/L、(55.8±10.1)ng/mL和(180.1±48.7)pg/mL,均显著低于对照组【分别为(288.1±31.5)μg/L、(80.1±11.3)ng/mL和(261.1±54.3)pg/mL,P＜0.05】;在随访1年末,观察组生存率为66.0%,对照组为46.7%,无显著性差异(Log-Rank=2.643,P=0.104)。结论靶向和免疫药物联合TACE治疗PLC患者可显著提高近期疗效,可能与提高了机体免疫功能有关,但远期疗效仍不理想。

关键词: 原发性肝癌, 靶向治疗, 免疫治疗, 肝动脉化疗栓塞术, 生存率

Abstract: Objective This study was conducted to investigate targeted and immunotherapy plus transarterial chemoembolization (TACE) in the treatment of patient with primary liver cancer (PLC). Methods A total of 100 PLC patients were encountered in our hospital between May 2021 and April 2023, randomly divided into control (n=50) and observation (n=50) groups, and all patients in the two groups underwent TACE for two to five times. Patients in the observation group received target medicine, including apatinib or cangvatinib, and immunomodulators, including carilizumab or trelizumab, etc., combination therapy for three months. Peripheral blood lymphocyte subsets were detected by FCM, serum AFP level were routinely obtained, and serum macrophage metastasis inhibitor (MIF) and vascular endothelial growth factor (VEGF) levels were determined by ELISA. Results By end of three month treatment, Objective response rate (ORR) in the observation group was 62.0%, much higher than 42.0% in the control group (P<0.05); after treatment, percentage of peripheral blood CD4⁺ cells and ratio of CD4⁺/CD8⁺cells in the observation group were (46.8±4.6)% and (1.8±0.3), both much higher than [(37.3±4.2)% and (1.3±0.3), respectively, P＜0.05], while percentage of CD8⁺ cells was (25.1±2.4)%, much lower than [(28.5±2.5)%, P＜0.05] in the control; serum AFP, MIF and VEGF levels were (110.2±27.5)μg/L, (55.8±10.1)ng/mL and (180.1±48.7)pg/mL, all significantly lower than [(288.1±31.5)μg/L, (80.1±11.3)ng/mL and (261.1±54.3)pg/mL, respectively, P＜0.05] in the control; by end of one-year follow-up, survival rate in the observation group was 66.0%, not statistically significantly different as compared to 46.7% in the control group (Log-Rank=2.643, P=0.104). Conclusin Targeted and immunotherapy with combination of TACE in dealing with patients with advanced PLC could get a satisfactory short-term clinical efficacy, which might be related to improvement of body immune functions, but the long-term efficacy should be investigated further.

Key words: Hepatoma, Targeted therapy, Immunotherapy, Transcatheter hepatic arterial chemoembolization, Survival

彭贺, 郝建玲, 黄建业, 李楠楠, 骆锦前. TACE术联合靶向和免疫治疗原发性肝癌患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 593-596.

Peng He, Hao Jianling, Huang Jianye, et al. Targeted and immunotherapy plus TACE in the treatment of patient with primary liver cancer[J]. Journal of Practical Hepatology, 2025, 28(4): 593-596.

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TACE术联合靶向和免疫治疗原发性肝癌患者疗效研究^*

Targeted and immunotherapy plus TACE in the treatment of patient with primary liver cancer

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