免疫治疗时代晚期肝癌患者从客观缓解到长期生存的机遇与挑战

摘要/Abstract

摘要： 免疫检查点抑制剂(ICIs)的应用显著改善了晚期肝细胞癌(HCC)患者的预后,并使部分患者获得完全缓解(CR)或部分缓解(PR)。然而,在临床实践中,CR仍较为罕见,且影像学评估与病理学结果常出现差异,部分患者表现为所谓的“空壳瘤”,这一现象对疗效判定与后续治疗决策提出了新的挑战。目前,HCC患者在免疫治疗后获得客观缓解后的管理策略尚无统一共识,主要包括继续免疫治疗、停药观察以及实施转化或局部治疗(如切除、肝移植、TACE、立体定向放疗等)。不同策略各具优势与局限,现有证据多来自回顾性研究和小样本真实世界数据,缺乏专门针对该问题的前瞻性临床试验。本文综述了HCC免疫治疗后CR/PR的发生率及其临床意义,探讨了“空壳瘤”现象与评估困境,总结了现阶段主要的管理策略并提出未来研究方向,旨在为临床实践和研究提供参考。

关键词: 肝细胞癌, 免疫治疗, 完全缓解, 部分缓解, 空壳瘤, 管理策略

范芯铷, 王庆, 周华邦, 汪慧. 免疫治疗时代晚期肝癌患者从客观缓解到长期生存的机遇与挑战[J]. 肝脏, 2025, 30(9): 1177-1179.

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