免疫联合SBRT治疗中晚期原发性肝癌患者疗效与安全性分析*

doi:10.3969/j.issn.1672-5069.2026.02.031

摘要/Abstract

摘要： 目的探讨应用免疫联合体部立体定向放射治疗(SBRT)中晚期原发性肝癌(PLC)患者的疗效和安全性。方法 2020年1月～2024年1月我院收治的121例中晚期PLC患者被随机分为对照组61例和观察组60例,分别接受SBRT或在SBRT治疗后联合卡瑞利珠单抗治疗。在治疗2个月后,观察客观缓解率(ORR)和疾病控制率(DCR),采用ELISA法检测血清甲胎蛋白(AFP)、胸苷激酶1(TK1)和异常凝血酶原(DCP)水平,使用流式细胞仪检测外周血T淋巴细胞和自然杀伤(NK)细胞水平,应用Kapkan-Meier法绘制生存曲线,采用Log-Rank检验。结果观察组ORR和DCR分别为60.0%和95.0%,均显著高于对照组的36.1%和82.0%(P＜0.05);治疗后,观察组血清AFP、TK1和DCP水平分别为(82.4±18.3)ng/mL、(1.6±0.3)μg/L和(27.5±3.2)mAU/mL,均显著低于对照组【分别为(143.6±31.9)ng/mL、(2.2±0.4)μg/L和(38.6±3.9)mAU/mL,P＜0.05】;观察组外周血CD3⁺细胞百分比、CD4⁺/CD8⁺细胞比值和NK细胞百分比分别为(70.5±4.7)%、(1.7±0.2)和(16.3±2.7)%,均显著高于对照组【分别为(60.8±4.3)%、(1.4±0.2)和(11.1±2.2),P＜0.05】;观察组不良反应发生率为53.3%,显著高于对照组的36.1%(P<0.05);随访1年,观察组生存率为80.0%,显著高于对照组的56.9%(P＜0.05)。结论采用免疫联合SBRT治疗中晚期PLC患者能增强抗肿瘤免疫功能,有效提高短期生存率,且用药安全。

关键词: 原发性肝癌, 体部立体定向放射治疗, 卡瑞利珠单抗, 治疗

Abstract: Objective The aim of this study was to investigate the safety and efficacy of immunotherapy and stereotactic body radiation therapy (SBRT) in the treatment of patients with advanced primary liver cancer (aPLC). Methods A total of 102 patients with aPLC were encountered in our hospital between January 2020 and January 2024, and were randomly assigned to receive SBRT in 61 patients in control or receive intravenous camrelizumab after SBRT in another 60 patients in observation. Objective response rate (ORR) and disease control rate (DCR) were observed. Serum alpha-fetoprotein (AFP), thymidine kinase 1 (TK1) and abnormal prothrombin (DCP) levels were measured by ELISA. Peripheral blood T lymphocyte and natural killer (NK) cells were measured by flow cytometry. Survival curves were drawn by Kapkan-Meier method and compared by Log-Rank test. Results The ORR and DCR in the observation group were 60.0% and 95.0%, both much higher than 36.1% and 82.0%(P＜0.05) in the control; after treatment, serum AFP, TK1 and DCP levels in the observation were (82.4±18.3)ng/mL, (1.6±0.3)μg/L and (27.5±3.2)mAU/mL, all much lower than [(143.6±31.9)ng/mL, (2.2±0.4)μg/L and (38.6±3.9)mAU/mL, respectively, P＜0.05] in the control; percentage of peripheral blood CD3⁺ cells, CD4⁺/CD8⁺ cell ratio and percentage of NK cells were (70.5±4.7)%,(1.7±0.2) and (16.3±2.7)%, all significantly higher than [(60.8±4.3)%, (1.4±0.2) and (11.1±2.2), respectively, P＜0.05] in the control; the incidence adverse effects in the observation was 53.3%, much higher than 36.1%(P<0.05) in the control; by end of one-year follow-up, the survival rate in the observation was 80.0%, much higher than 56.9%(P＜0.05) in the control group. Conclusion Immunotherapy after SBRT in the treatment of patients with aPLC is efficacious, which could prolong short-term survival and merits further clinical investigation.

Key words: Hepatoma, Stereotactic body radiation therapy, Camrelizumab, Safety, Therapy

蒋楠, 刘泉, 郝福荣. 免疫联合SBRT治疗中晚期原发性肝癌患者疗效与安全性分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 285-288.

Jiang Nan, Liu Quan, Hao Furong. Safety and efficacy of immunotherapy and stereotactic body radiation therapy in the treatment of patients with advanced primary liver cancer[J]. Journal of Practical Hepatology, 2026, 29(2): 285-288.

参考文献

[1] 王秀芝,常金,宋丹,等. 卡瑞利珠单抗联合阿帕替尼治疗晚期原发性肝癌患者效果研究. 实用肝脏病杂志,2024,27(4):591-594.
[2] Tabrizian P, Abdelrahim M, Schwartz M. Immunotherapy and transplantation for hepatocellular carcinoma. J Hepatol, 2024,80(5):822-825.
[3] Pan J, Zhang M, Dong L, et al. Genome-scale CRISPR screen identifies LAPTM5 driving lenvatinib resistance in hepatocellular carcinoma. Autophagy, 2023,19(4):1184-1198.
[4] Sankar K, Gong J, Osipov A, et al. Recent advances in the management of hepatocellular carcinoma. Clin Mol Hepatol, 2024,30(1):1-15.
[5] Chen Q, Zheng W, Guan J, et al. SOCS2-enhanced ubiquitination of SLC7A11 promotes ferroptosis and radiosensitization in hepatocellular carcinoma. Cell Death Differ, 2023,30(1):137-151.
[6] Llovet JM, Pinyol R, Yarchoan M, et al. Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma. Nat Rev Clin Oncol, 2024,21(4):294-311.
[7] 黄丛秀,王少军,林宇,等. 放疗序贯免疫治疗Ⅲ期非小细胞肺癌的真实世界研究. 中华放射肿瘤学杂志,2025,34(1):57-64.
[8] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 中华消化外科杂志,2020,19(1):1-20.
[9] Litière S, Isaac G, De Vries EGE, et al. RECIST 1.1 for response evaluation apply not only to chemotherapy-treated patients but also to targeted cancer agents: a pooled database analysis. J Clin Oncol, 2019,37(13):1102-1110.
[10] Yang X, Yang C, Zhang S, et al. Precision treatment in advanced hepatocellular carcinoma. Cancer Cell, 2024,42(2):180-197.
[11] Norman JS, Li PJ, Kotwani P, et al. AFP-L3 and DCP strongly predict early hepatocellular carcinoma recurrence after liver transplantation. J Hepatol, 2023,79(6):1469-1477.
[12] Dilek ON, Arslan Kahraman D, Kahraman G. Carcinoembryonic antigen in the diagnosis, treatment, and follow-up of focal liver lesions. World J Gastrointest Surg, 2024,16(4):999-1007.
[13] Li Z, Wu Z, You X, et al. Pan-cancer analysis reveals that TK1 promotes tumor progression by mediating cell proliferation and Th2 cell polarization. Cancer Cell Int, 2024,24(1):329.
[14] Pang BY, Leng Y, Wang X, et al. A meta-analysis and of clinical values of 11 blood biomarkers, such as AFP, DCP, and GP73 for diagnosis of hepatocellular carcinoma. Ann Med, 2023,55(1):42-61.
[15] Bae SH, Chun SJ, Chung JH,et al. Stereotactic body radiation therapy for hepatocellular carcinoma: meta-analysis and international stereotactic radiosurgery society practice guidelines. Int J Radiat Oncol Biol Phys, 2024,118(2):337-351.
[16] Gutman MJ, Serra LM, Koshy M, et al. SBRT for liver tumors: what the interventional radiologist needs to know. Semin Intervent Radiol, 2024,41(1):1-10.
[17] Dopazo C, Søreide K, Rangelova E, et al. Hepatocellular carcinoma. Eur J Surg Oncol, 2024,50(1):107313.
[18] Tang J, Zhang S, Jiang L,et al. Causal relationship between immune cells and hepatocellular carcinoma: a Mendelian randomisation study. J Cancer, 2024,15(13):4219-4231.
[19] Aoki T, Nishida N, Kurebayashi Y, et al. Two distinct characteristics of immune microenvironment in human hepatocellular carcinoma with Wnt/β-catenin mutations. Liver Cancer, 2023,13(3):285-305.
[20] Wang S, Wu Q, Chen T, et al. Blocking CD47 promotes antitumour immunity through CD103⁺ dendritic cell-NK cell axis in murine hepatocellular carcinoma model. J Hepatol, 2022,77(2):467-478.

免疫联合SBRT治疗中晚期原发性肝癌患者疗效与安全性分析^*

Safety and efficacy of immunotherapy and stereotactic body radiation therapy in the treatment of patients with advanced primary liver cancer

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