微创医学

目的探讨信迪利单抗联合盐酸安罗替尼胶囊及肝动脉化疗栓塞术对不可切除晚期肝细胞癌的降期转化效果。方法回顾性分析45例不可切除晚期肝细胞癌患者的临床资料。所有患者均接受信迪利单抗联合盐酸安罗替尼胶囊及肝动脉化疗栓塞术治疗，对符合降期转化为可切除肝细胞癌标准的患者给予手术切除，并观察术后复发及转移情况。结果 45例患者中，13例（28.89%）成功降期转化为可切除肝细胞癌并接受肝细胞癌切除术。转化治疗期间，13例患者接受肝动脉化疗栓塞术治疗2～5（3.15±0.80）次，药物治疗4～9（5.85±1.95）个周期，不良事件通用术语评价标准分级均为1～2级，治疗相关不良事件均为耐受，主要为手足综合征6例、甲状腺功能减退4例、高血压3例，未发生治疗相关死亡事件。13例患者术前均接受抗病毒治疗（5例使用富马酸丙酚替诺福韦酯片，8例使用恩替卡韦胶囊）。转化治疗后，13例患者甲胎蛋白水平由治疗前的1.84～8 857.23（1 235.92±690.98）ng/mL降至1.65～656.45（82.53±54.97）ng/mL。转化成功的13例患者均顺利完成手术切除，手术时间100～208（159.38±35.71）min，术中出血量100～800（353.85±170.12）mL。术后病理显示1例患者未见明确肿瘤细胞残留，12例患者可见残余癌组织。术后随访时间为16～78（46.54±22.78）周，6例患者无复发，5例患者出现肿瘤肝内复发，2例患者出现远处转移病灶（脾、肺各1例），整体复发率为53.85%。术后并发症包括胸腹腔积液2例、腹腔积液2例、腹腔感染4例、肺部感染3例、切口感染1例及术后出血1例，经对症治疗后均好转，无围手术期死亡事件。结论信迪利单抗联合盐酸安罗替尼胶囊及肝动脉化疗栓塞术治疗不可切除晚期肝细胞癌患者，降期转化效果尚可，安全性较好。

Objective To explore the downstaging conversion effect of sintilimab combined with anlotinib hydrochloride capsules and transarterial chemoembolization in unresectable advanced hepatocellular carcinoma. Methods A retrospective analysis was conducted on the clinical data of 45 patients with unresectable advanced hepatocellular carcinoma. All patients received treatment with sintilimab combined with anlotinib hydrochloride capsules and transarterial chemoembolization. Surgical resection was performed in patients who met the criteria for downstaging conversion to resectable hepatocellular carcinoma, and postoperative recurrence and metastasis were observed. Results Of the 45 patients, 13 cases (28.89%) successfully downstaged and converted to resectable hepatocellular carcinoma, and subsequently underwent hepatectomy. During conversion therapy, these 13 patients received 2-5 (3.15±0.80) sessions of transarterial chemoembolization and 4-9 (5.85±1.95) cycles of medication. All adverse events were graded as grade 1-2 according to the common terminology criteria for adverse events. All treatment-related adverse events were well-tolerated, mainly including hand-foot syndrome (6 cases), hypothyroidism (4 cases) and hypertension (3 cases). No treatment-related deaths occurred. All 13 patients received antiviral therapy preoperatively, including 5 cases treated with tenofovir alafenamide fumarate tablets and 8 cases with entecavir capsules. After conversion therapy, the alpha-fetoprotein levels of the 13 patients decreased from 1.84-8 857.23 (1 235.92±690.98) ng/mL before treatment to 1.65-656.45 (82.53±54.97) ng/mL. All 13 patients with successful conversion underwent uneventful surgical resection. The operation time was 100-208 (159.38±35.71) min, and the intraoperative blood loss was 100-800 (353.85±170.12) mL. Postoperative pathology revealed no obvious residual tumor cells in 1 patient, and residual cancer tissue was present in 12 patients. The postoperative follow-up period was 16-78 (46.54±22.78) weeks. Six patients remained recurrence-free, 5 cases developed intrahepatic tumor recurrence, and 2 cases had distant metastatic lesions (1 in the spleen and 1 in the lung), with an overall recurrence rate of 53.85%. Postoperative complications included pleural and peritoneal effusion (2 cases), peritoneal effusion (2 cases), abdominal infection (4 cases), pulmonary infection (3 cases), incision infection (1 case), and postoperative bleeding (1 case). All complications improved after symptomatic treatment, and no perioperative deaths occurred. Conclusion Sintilimab combined with anlotinib hydrochloride capsules and transarterial chemoembolization shows favorable downstaging conversion efficacy and good safety in patients with unresectable advanced hepatocellular carcinoma.

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