特瑞普利单抗联合仑伐替尼在TACE治疗晚期肝癌中的应用效果

摘要/Abstract

摘要： 目的探讨特瑞普利单抗联合仑伐替尼在肝动脉化疗栓塞术(TACE)治疗晚期肝癌中的应用。方法选取2020年9月至2024年9月菏泽市成武县人民医院收治的晚期肝癌患者150例,随机分为对照组(仑伐替尼+TACE)与观察组(在对照组基础上加用特瑞普利单抗),每组各75例。比较两组治疗效果及1年后的生存情况。结果治疗后,观察组客观缓解率为58.67%(44/75),高于对照组的37.33%(28/75)(χ²=6.838,P=0.009)。观察组血管内皮生长因子、缺氧诱导因子-1α、成纤维细胞生长因子、甲胎蛋白、糖类抗原19-9、AST、ALT水平分别为(203.27±25.68)pg/mL、(30.86±4.59)ng/L、(20.42±2.97)pg/mL、(212.24±25.89)ng/mL、(49.26±9.37)U/mL、(51.28±9.85)U/L、(52.33±4.25)U/L,对照组分别为(228.15±22.17)pg/mL、(36.37±5.24)ng/L、(26.15±3.46)pg/mL、(271.61±23.47)ng/mL、(58.73±10.16)U/mL、(62.61±10.37)U/L、(59.74±5.69)U/L,两组比较差异均有统计学意义(P<0.05)。治疗后,两组不良反应发生率差异无统计学意义(P>0.05)。观察组1年存活率为58.67%(44/75),高于对照组的34.67%(26/75)(P<0.05)。结论在TACE治疗晚期肝癌的基础上,联合应用特瑞普利单抗与仑伐替尼可显著提高客观缓解率,降低肿瘤标志物及血管生成相关因子水平,改善肝功能,且未增加不良反应发生率,有助于提高患者近期生存率。

关键词: 特瑞普利单抗, 仑伐替尼, 肝动脉化疗栓塞术, 晚期肝癌, 临床疗效

Abstract: Objective To investigate the efficacy of toripalimab combined with lenvatinib in the treatment of advanced liver cancer with transarterial chemoembolization (TACE). Methods A total of 150 patients with advanced liver cancer admitted to our hospital between September 2020 and September 2024 were enrolled. They were randomly assigned to the control group (lenvatinib plus TACE) and the observation group (lenvatinib + TACE combined with toripalimab), with 75 patients in each group. The therapeutic efficacy of the two groups was compared after treatment, and their survival status was followed up for 1 year. Results After treatment, the objective response rate (ORR) of the observation group reached 58.67%, which was notably higher compared to the 34.67% recorded in the control group (P<0.05). Regarding serum indicators, the observation group showed respective levels of vascular endothelial growth factor, hypoxia-inducible factor-1α, basic fibroblast growth factor, alpha-fetoprotein, carbohydrate antigen 19-9, aspartate aminotransferase, and alanine aminotransferase of (203.27±25.68) pg/mL, (30.86±4.59) ng/L, (20.42±2.97) pg/mL, (212.24±25.89) ng/mL, (49.26±9.37) U/mL, (51.28±9.85) U/L, and (52.33±4.25) U/L, respectively, which were significantly lower than those in the control group[(228.15±22.17) pg/mL, (36.37±5.24) ng/L, (26.15±3.46) pg/mL, (271.61±23.47) ng/mL, (58.73±10.16) U/mL, (62.61±10.37) U/L, (59.74±5.69) U/L], with statistical significance (P<0.05). The two groups had similar adverse reaction incidences (P>0.05). However, the observation group had a significantly higher 1-year survival rate (58.67%) than the control group (34.67%) (P<0.05). Conclusion The combination of toripalimab and lenvatinib with TACE in the treatment of advanced liver cancer can significantly improve the objective response rate, reduce tumor markers and angiogenesis-related factors, improve liver function, and increase prolong short-term survival without increasing the incidence of adverse reactions.

Key words: Toripalimab, Lenvatinib, Transarterial chemoembolization, Advanced liver cancer, Clinical efficacy

栾欣英, 赵金侠, 孙硕, 陈雨晨. 特瑞普利单抗联合仑伐替尼在TACE治疗晚期肝癌中的应用效果[J]. 肝脏, 2026, 31(6): 826-830.

Luan Xinying, Zhao Jinxia, Sun Shuo, Chen Yuchen. A study on the efficacy of toripalimab combined with lenvatinib in TACE treatment for advanced liver cancer[J]. Chinese Hepatolgy, 2026, 31(6): 826-830.

/ 推荐

参考文献

[1] 周国辉.仑伐替尼联合信迪利单抗对晚期肝癌患者肿瘤标志物水平及生存情况的影响[J]. 哈尔滨医药,2025,45(2): 4-7.
[2] 吴小龙,邓婧,罗韬.特瑞普利单抗联合仑伐替尼TACE治疗晚期肝癌的疗效及对肿瘤标志物预后的影响[J]. 河北医学,2024,30(10): 1745-1751.
[3] Dang Z, Jiang L, Huang F. Effect of bevacizumab administered prior to transarterial chemoembolization on the therapeutic effects of lenvatinib given post-TACE in primary liver cancer patients[J]. Int J Clin Pharmacol Ther,2023,61(10): 423-429.
[4] Ning S, Li X, Ma X, et al. Efficacy of TACE combined with lenvatinib plus sintilimab for hepatocellular carcinoma with tumor thrombus in the inferior vena cava and/or right atrium[J]. J Hepatocell Carcinoma,2023,10(13): 1511-1525.
[5] Chen J Y, Huang N S, Wei W J, et al. The efficacy and safety of surufatinib combined with anti PD-1 antibody toripalimab in neoadjuvant treatment of locally advanced differentiated thyroid cancer:a phase Ⅱ study[J]. Ann Surg Oncol,2023,30(12): 7172-7180.
[6] 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J]. 中华消化外科杂志,2017,16(7): 635-647.
[7] Lencioni R, Llovet J M. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma[J]. Semin Liver Dis,2010,30(1): 52-60.
[8] Huang D Q, Singal A G, Kono Y, et al. Changing global epidemiology of liver cancer from 2010 to 2019: NASH is the fastest growing cause of liver cancer[J]. Cell Metab,2022,34(7): 969-977.
[9] 杨建奇,曹文淼,吴银霞,等.卡瑞利珠单抗或信迪利单抗联合仑伐替尼治疗肝癌的效果及对肿瘤标志物的影响[J]. 肝脏,2022,27(10): 1080-1083.
[10] 曹静,夏晓阳,尤冬山,等.卡瑞利珠单抗联合仑伐替尼或阿帕替尼对晚期肝癌患者肝功能及肿瘤标志物的影响[J]. 肝脏,2023,28(12): 1440-1445.
[11] Singh S, Singh N, Baranwal M, et al. Understanding immune checkpoints and PD-1/PD-L1-mediated immune resistance towards tumour immunotherapy[J]. 3 Biotech,2023,13(12): 411.
[12] 罗详冲. 特瑞普利单抗在恶性肿瘤治疗中的应用[J]. 中国肿瘤生物治疗杂志,2020,27(8): 946-950.
[13] 李楠,陈新宇,秋玉珍,等.特瑞普利单抗辅助FOLFOX治疗对进展期胃癌患者血管新生和PD-1/PD-L1信号通路的影响[J]. 海南医学,2025,36(1): 6-11.
[14] 宋春荣,南然,刘永刚,等.益脾养肝方对肝郁脾虚证原发性肝癌TACE患者bFGF、VEGF、AFP-L3及免疫功能影响[J]. 辽宁中医药大学学报,2022,24(1): 80-84.
[15] 赵容,李静,严涵,等.柴胡化积方对原发性肝癌TACE术后综合征外周血炎症因子及bFGF、MMP-9、VEGF水平的影响[J]. 湖南中医药大学学报,2023,43(12): 2328-2334.
[16] 孟元普,裴哲,周博.卡瑞利珠单抗联合mFOLFIRI方案对结肠癌的疗效及其对血管新生指标及恶性细胞增殖活性的影响[J]. 实用癌症杂志,2023,38(9): 1502-1506.
[17] Ucaryilmaz Metin C, Ozcan G. The HIF-1α as a potent inducer of the hallmarks in gastric cancer[J]. Cancers (Basel),2022,14(11): 2711.
[18] Shan Q, Yin L, Zhan Q, et al. The p-MYH9/USP22/HIF-1α axis promotes lenvatinib resistance and cancer stemness in hepatocellular carcinoma[J]. Signal Transduct Target Ther,2024,9(1): 249.
[19] 李园园,骆娇娇,李卫,等.卡瑞利珠单抗联合仑伐替尼治疗中晚期肝癌的疗效观察[J]. 中华保健医学杂志,2024,26(5): 702-704.
[20] 张鸿渐,段小辉,张恒,等.血清甲胎蛋白和CA19-9对混合型肝癌根治术预后的影响[J]. 中华肝胆外科杂志,2025,31(2): 87-91.
[21] Lin R, Fu X, Huang J. Relationship between changes of serum vascular endothelial growth factor and folate receptor-α levels and clinical efficacy of toripalimab in patients with bladder cancer[J]. Arch Esp Urol,2024,77(1): 31-37.
[22] 刘妍,马珊,付正传.PD-1抑制剂联合乐伐替尼治疗原发性肝癌的疗效及对血清血管内皮生长因子、可溶性血管细胞黏附因子的影响[J]. 中国中西医结合外科杂志,2023,29(2): 211-215.
[23] 黎明,韩明锦,李子杰.肝动脉化疗栓塞术联合特瑞普利单抗治疗肝癌临床观察[J]. 天津药学,2023,35(3): 53-56.
[24] 彭国文,史德刚,王健鹏,等.TACE联合索拉非尼及特瑞普利治疗中晚期原发性肝癌的效果[J]. 长治医学院学报,2022,36(5): 339-343.