定期保肝治疗对仑伐替尼治疗晚期肝癌合并Child-Pugh B级肝硬化患者生存期的影响

摘要/Abstract

摘要： 目的探究定期保肝治疗对应用仑伐替尼为基础治疗的晚期肝癌伴Child-Pugh B级肝硬化患者生存期的影响。方法随机选取我院在2019年4月至2024年4月确诊的晚期肝癌伴Child-Pugh B级肝硬化患者,所有患者均接受以仑伐替尼为基础的治疗,共48例,根据是否接受保肝治疗分为保肝组(n=33,多烯磷脂酰胆碱联合甘草酸单胺半胱氨酸治疗)和未保肝组(n=17)。比较两组中位生存期(MST)、总生存期(OS)及生存率,并分析不同影像学特征(门静脉癌栓vs. 肝外转移)及治疗方案(仑伐替尼±TACE/PD-1)的差异。结果保肝组MST(18个月)和OS(22个月)显著优于未保肝组(7个月、8个月,P<0.01)。半年、1年、2年生存率分别为90.32%、70.97%、29.03%,均显著高于未保肝组(70.05%、17.64%、0%,P<0.01)。亚组分析显示:肝癌伴门静脉癌栓A组OS为14个月,MST为10个月,肝外转移B组OS为18个月,MST为16个月,B组较A组显著延长(P<0.01);保肝治疗后:A组OS为22个月,MST为17个月,B组OS和MST均为22个月,差异无统计学意义(χ²=1.65,P>0.05)。对仑伐替尼单药、仑伐替尼+TACE、仑伐替尼+PD-1、仑伐替尼+PD-1+TACE各治疗组生存期及生存率进行比较,结果显示保肝组MST分别为:19个月、16个月、18个月、24个月,未保肝组分别为7个月、4个月、5个月、9个月,P<0.05;1年生存率分别为63.6%、75%、66.67%、100%,明显高于未保肝组的0、0、20%、50%(P<0.05)。结论对晚期肝癌伴Child-Pugh B级肝硬化患者应用以仑伐替尼为基础治疗的过程中,给予定期保肝支持治疗可以明显延长患者生存期,提高生存率和生活质量。

关键词: 甘草酸单胺半胱氨酸, 多烯磷脂酰胆碱, Child-PughB级肝硬化, 晚期肝癌, 仑伐替尼, 生存率

Abstract: Objective To investigate the impact of scheduled hepatoprotective therapy on survival outcomes in lenvatinib-based treatment advanced hepatocellular carcinoma (HCC) patients with and Child-Pugh B (CP-B) cirrhosis. Methods A total of 48 patients diagnosed with advanced HCC and CP-B cirrhosis between April 2019 and April 2024 were retrospectively enrolled and divided into two groups: the hepatoprotection group (n=33, receiving polyene phosphatidylcholine combined with monoammonium glycyrrhizinate-cysteine) and the non-hepatoprotection group (n=17). Median survival time (MST), overall survival (OS), and survival rates were compared between the two groups. Subgroup analyses were performed based on imaging characteristics (portal vein tumor thrombus [PVTT] vs. extrahepatic metastasis) and treatment regimens (lenvatinib±TACE/PD-1). Results The hepatoprotection group demonstrated superior survival outcomes, with MST of 18 months (versus 7 months) and OS of 22 months (versus 8 months) compared to controls (both P<0.01). Survival rates at 6, 12, and 24 months were 90.32%, 70.97%, and 29.03% respectively in the hepatoprotection group, significantly higher than those in the non-hepatoprotective group (70.05%, 17.64%, and 0%, P<0.01). Subgroup analysis revealed comparable survival benefits regardless of tumor extension pattern (portal invasion versus distant metastases). Notably, combination therapies incorporating hepatoprotection showed consistently better outcomes across all regimens, with particular benefit observed in the lenvatinib plus TACE and PD-1 inhibitor subgroup (1-year survival 100% versus 50% in unprotected patients). Conclusion Scheduled hepatoprotective therapy significantly prolongs survival, improves survival rates, and enhances quality of life lenvatinib-treated advanced HCC patients with Child-Pugh B cirrhosis.

Key words: Monoammonium glycyrrhizinate-cysteine, Polyene phosphatidylcholine, Child-Pugh B cirrhosis, Advanced hepatocellular carcinoma, Lenvatinib, Survival time, Survival rate

胡侠, 张逸晟, 卢成鸿, 潘华将, 钟在文, 杨洋. 定期保肝治疗对仑伐替尼治疗晚期肝癌合并Child-Pugh B级肝硬化患者生存期的影响[J]. 肝脏, 2026, 31(5): 658-663.

HU Xia, ZHANG Yi-sheng, LU Cheng-hong, PAN Hua-jiang, ZHONG Zai-wen, YANG Yang. Impact of scheduled hepatoprotective therapy on survival in lenvatinib-treated advanced HCC patients with Child-Pugh B cirrhosis[J]. Chinese Hepatolgy, 2026, 31(5): 658-663.

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