介入联合靶向免疫治疗肝细胞癌的研究进展

Recent Advances in Interventional Therapy Combined with Targeted Therapy and Immunotherapy for Hepatocellular Carcinoma

摘要: 肝细胞癌(HCC)是原发性肝癌中最常见的病理类型。由于早期症状不典型，很多患者确诊时已处于中晚期，失去了手术切除、肝移植或局部消融等根治性治疗机会。介入治疗在肝细胞癌综合治疗中一直占有重要地位，其中经动脉化疗栓塞(TACE)和肝动脉灌注化疗(HAIC)在控制肝内病灶、降低肿瘤负荷方面具有较大价值。近几年，随着靶向治疗和免疫治疗不断发展，介入联合靶向免疫治疗逐渐成为研究热点。现有研究提示，介入治疗不仅能够直接减瘤，还可能通过促进抗原释放和改变肿瘤微环境，为后续系统治疗创造条件；靶向治疗和免疫治疗则有助于进一步增强抗肿瘤效应。目前，TACE或HAIC联合靶向免疫治疗在不可切除肝细胞癌、高肿瘤负荷肝细胞癌以及部分有转化需求的患者中显示出一定应用前景。本文就介入联合靶向免疫治疗肝细胞癌的理论基础、临床研究进展及应用价值作一综述，以期为临床治疗提供参考。

Abstract: Hepatocellular carcinoma (HCC) is the most common histological subtype of primary liver cancer. Owing to the lack of specific symptoms at the early stage, many patients are diagnosed at an intermediate or advanced stage and consequently lose the opportunity to undergo potentially curative treatments such as surgical resection, liver transplantation, or local ablation. Interventional therapy has long played an important role in the multidisciplinary management of HCC, among which transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) are of substantial value in controlling intrahepatic lesions and reducing tumor burden. In recent years, with the continuous development of targeted therapy and immunotherapy, interventional therapy combined with targeted therapy and immunotherapy has gradually become a major focus of research. Available evidence suggests that interventional therapy not only exerts a direct tumor-reducing effect, but may also promote antigen release and modulate the tumor microenvironment, thereby creating favorable conditions for subsequent systemic treatment. Targeted therapy and immunotherapy may further enhance antitumor efficacy. At present, TACE- or HAIC-based combination strategies with targeted therapy and immunotherapy have shown promising application prospects in patients with unresectable HCC, HCC with high tumor burden, and selected patients requiring conversion therapy. This article reviews the theoretical basis, clinical research progress, and clinical value of interventional therapy combined with targeted therapy and immunotherapy for HCC, with the aim of providing a reference for clinical practice.