目的

探讨微波消融（microwave ablation， MWA）同步肝动脉插管化疗栓塞（transcatheter arterial chemoembolization， TACE）联合靶向免疫治疗在不可切除肝癌中的临床疗效及安全性。

方法

回顾性分析2021 年1 月至2024 年9 月在青岛大学附属医院接受MWA 同步TACE 联合靶向及免疫药物治疗的17 例大肝癌患者，肝功能为Child-Pugh A、B 级，在CT 引导下行MWA 术后立即进行TACE 术，术后1 周内联合靶向及免疫药物治疗。主要评估疾病控制率、客观缓解率、无进展生存期、总生存期及安全性。采用Kaplan-Meier 法绘制生存曲线，Log-rank 检验比较患者生存率，并进行Cox 回归多因素分析。随访分析疗效及安全性。

结果

该技术在所有患者中均成功应用。17 例患者中，完全缓解3 例（17.6%），部分缓解11 例（64.7%），疾病稳定1 例（5.8%），疾病进展2 例（11.8%），客观缓解率为82.3%，疾病控制率为88.2%。中位无进展生存期未达到。中位总生存期未达到，6、12、24 个月的生存期率分别为100%、93.8%、68.8%。在10 例巴塞罗那临床肝癌分期系统为C 期的患者中中位总生存期为20 个月。无出血或其他相关并发症。在靶向及免疫药物治疗过程安全性评估中，其中3 例（17.6%）发生3 级不良事件，1～3 级不良事件予以对症处理后可缓解。

结论

MWA 同步TACE 联合靶向免疫治疗大肝癌安全有效，为大肝癌的临床治疗提供了新的思路与选择，改善大肝癌患者的预后。

Objective

To explore the clinical efficacy and safety of microwave ablation （MWA）combined with synchronous transarterial chemoembolization （TACE） and targeted immunotherapy in unresectable liver cancer.

Methods

We conducted a retrospective analysis of patient records from January 2021 to September 2024， involving 17 patients with large hepatocellular carcinoma who received MWA combined with synchronous TACE and targeted and immunotherapeutic drugs in our hospital， with Child-Pugh class A or B liver function.The study involved performing MWA under CT guidance， immediately followed by TACE， and initiating a combination of targeted therapy and immunotherapy within one week post-procedure.The primary endpoints included Disease Control Rate （DCR）， Objective Response Rate （ORR）， Progression-Free Survival（PFS）， Overall Survival （OS）， and safety.Statistical analysis was conducted using the Kaplan-Meier method to construct survival curves， the Log-rank test to compare patient survival rates， and Cox regression for multivariate analysis.Efficacy and safety were evaluated during follow-up.

Results

This technique was successfully applied in all patients.Among the 17 patients， 3 cases （17.6%） achieved complete remission （CR）， 11 cases （64.7%）achieved partial remission （PR）， 1 case （5.8%） presented with stable disease （SD）， while 2 cases （11.8%） had progressive disease （PD）.The objective response rate （ORR）， calculated as the sum of complete response（CR） and partial response （PR）， reached 82.3%.The disease control rate （DCR） was 88.2%.Moreover， the median progression-free survival （PFS） was not reached.The median OS was not reached.The survival rates at 6 months， 12 months， and 24 months were 100%， 93.8%， and 66.8%， respectively.Among the 10 patients with BCLC stage C， the median overall survival （OS） was 20 months.There were no bleeding or other related complications.In the safety assessment during the treatment with targeted and immunotherapeutic drugs， the overall incidence of adverse events was 100.0%.Among them， 3 cases （17.6%） had grade 3 adverse events， and grade 1-3 adverse events could be relieved after symptomatic treatment.

Conclusion

MWA combined with synchronous TACE and targeted immunotherapy is safe and effective for the treatment of large hepatocellular carcinoma.This offers new approaches and options for the clinical treatment of large hepatocellular carcinoma，improving the prognosis for patients with large liver cancer.