经动脉介入联合靶向及免疫治疗在肝细胞癌综合治疗中的应用进展

Advances in Transarterial Interventional Therapy Combined with Targeted Therapy and Immunotherapy for the Comprehensive Treatment of Hepatocellular Carcinoma

摘要: 肝细胞癌(Hepatocellular Carcinoma, HCC)在我国仍呈现发病负担重、死亡率高和初诊中晚期比例高等特点。随着《原发性肝癌诊疗指南(2026年版)》发布以及靶向、免疫治疗证据快速更新，经导管动脉化疗栓塞术(Transarterial Chemoembolization, TACE)、肝动脉灌注化疗(Hepatic Arterial Infusion Chemotherapy, HAIC)与系统治疗的联合应用已成为不可切除HCC治疗的重要研究方向。现有证据表明，TACE联合靶向及免疫治疗可在部分患者中延长无进展生存期或TACE相关无进展生存期(TACE-progression-free survival, TACE-PFS)，但其总生存获益尚未形成一致结论；HAIC在高肿瘤负荷、门静脉癌栓和转化治疗中具有较强减瘤潜力，但其较现代靶免双联方案的额外价值仍缺乏头对头随机研究验证。本文围绕TACE或HAIC联合靶向治疗及免疫检查点抑制剂的理论基础、临床证据、介入治疗决策及转化治疗价值进行综述，并提出基于预期TACE抵抗、肝功能保护和转化潜力的临床选择框架。从外科视角看，应重视转化治疗后的再评估、围手术期安全性、术后复发风险以及后续治疗机会的保留。未来研究应将肝功能保持、病理学缓解、R0切除、术后无复发生存和总生存等具有临床意义的指标纳入重要研究终点。

Abstract: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related morbidity and mortality in China, with many patients diagnosed at intermediate or advanced stages. With the release of the 2026 Chinese guideline for primary liver cancer and the rapid evolution of targeted and immune-based therapies, transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) combined with systemic therapy have become important strategies for unresectable HCC. Current evidence suggests that TACE-based combinations may prolong progression-free survival or TACE-related progression-free survival (TACE-PFS) in selected patients; however, a consistent overall survival benefit has not been established. HAIC may be particularly useful for patients with portal vein tumor thrombus, high intrahepatic tumor burden, or potential conversion to resection, but direct evidence comparing HAIC-based triplet therapy with contemporary immunotherapy-based doublets is still lacking. This review summarizes the rationale, clinical evidence, interventional decision-making, and conversion value of TACE or HAIC combined with targeted therapy and immune checkpoint inhibitors. A practical framework based on anticipated TACE refractoriness, liver function preservation, and conversion potential is proposed. From a surgical perspective, conversion assessment, perioperative safety, postoperative recurrence risk, and preservation of future treatment opportunities should be emphasized. Future trials should incorporate liver function preservation, pathological response, R0 resection, postoperative recurrence-free survival, and overall survival as clinically meaningful endpoints.