Treatment modalities for advanced hepatocellular carcinoma (HCC) have changed dramatically, with systemic therapy as the primary option. However, the effect of sequential treatment on prognosis remains unclear. This retrospective study included patients who began systemic therapy between 2009 and 2022. The patients were separated into three groups according to systemic therapy commencement. The number of therapy lines, treatment efficacy, and overall survival (OS) were compared. Multivariate analyses of the prognostic factors were analyzed using the Cox proportional hazards model. Overall, 336 patients were included (period 1: 2009–2013,n= 86; period 2: 2014–2018,n= 132; period 3: 2019–2022,n= 118). A significant etiological trend was observed with decreasing viral hepatitis-related HCC and increasing non-viral hepatitis-related HCC. Across periods 1–3, the proportion of patients who were administered >2 lines progressively increased (1.2%, 12.9%, and 17.0%, respectively;p< 0.001) and the median OS was significantly prolonged (14.3, 16.8, and 31.0 months;p< 0.001). The use of <3 lines, the non-complete and partial response of the first line, modified albumin–bilirubin at grade 2b or 3, an intrahepatic tumor number ≥ 5, extrahepatic metastasis, and alpha-fetoprotein at ≥400 ng/mL were the strongest factors associated with shorter OS. Sequential therapies have contributed to significant improvements in HCC prognosis, suggesting that sequential treatment post-progression is worthwhile for better survival.
晚期肝细胞癌（HCC）的治疗模式已发生显著变化，系统性治疗成为主要选择。然而，序贯治疗对预后的影响尚不明确。本回顾性研究纳入了2009年至2022年间开始系统性治疗的患者，根据开始治疗的时间将患者分为三组，比较了治疗线数、疗效及总生存期（OS），并采用Cox比例风险模型对预后因素进行多变量分析。研究共纳入336例患者（时期1：2009–2013年，n=86；时期2：2014–2018年，n=132；时期3：2019–2022年，n=118）。观察到显著的病因学趋势：病毒性肝炎相关HCC减少，非病毒性肝炎相关HCC增加。从时期1到时期3，接受>2线治疗的患者比例逐步上升（分别为1.2%、12.9%和17.0%；p<0.001），中位OS显著延长（14.3、16.8和31.0个月；p<0.001）。治疗线数<3、一线治疗未达完全或部分缓解、改良白蛋白-胆红素分级为2b或3级、肝内肿瘤数量≥5、肝外转移以及甲胎蛋白≥400 ng/mL是与较短OS相关的最强因素。序贯治疗显著改善了HCC的预后，表明疾病进展后继续序贯治疗对提高生存率具有重要价值。
Survival Improvements in Advanced Hepatocellular Carcinoma with Sequential Therapy by Era
肿瘤(癌症)患者之家