Background:The treatment landscape for advanced hepatocellular carcinoma (HCC) has evolved significantly recently; however, access to novel agents remains limited because of high costs. This study aimed to evaluate the systemic treatment patterns and survival outcomes for advanced HCC across different systemic treatment sequences under real-world resource constraints.Methods:This retrospective study was conducted at a tertiary center in Southern Thailand. The medical records of patients (n= 330) with advanced HCC treated with systemic therapy between 2010 and 2024 were reviewed. Outcomes included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Prognostic factors for OS were investigated.Results:First-line therapies included tyrosine kinase inhibitor (TKI; 69.7%), chemotherapy (23.3%), immunotherapy (IO)/targeted therapy (3.6%), dual IO (1.8%), and IO monotherapy (1.5%). The median OS, PFS, and ORR for each cohort were 7.2, 5.2, 10.9, 8.5, and 8.6 months; 3.94, 3.22, 3.48, 6.19, and 2.69 months; and 9.6%, 10.4%, 16.7%, 0%, and 20.0%, respectively. OS improved with increasing lines of therapy (4.5, 12.2, 19.4, and 40.7 months for one to four lines, respectively). Portal vein tumor thrombus, ascites, elevated bilirubin level, high alpha-fetoprotein level, and poor Eastern Cooperative Oncology Group performance status were associated with poor prognosis; multiple treatment lines and overweight status were associated with improved OS.Conclusions:In this large real-world cohort, TKIs remained the mainstay effective treatment option because of limited access to IO-based regimens. Sequential systemic therapy significantly improved survival, emphasizing the importance of preserving treatment eligibility and multidisciplinary team involvement. Chemotherapy could be considered a viable option in resource-limited settings.
背景：近年来晚期肝细胞癌（HCC）的治疗格局已发生显著变化，但由于高昂费用，新型药物的可及性仍然有限。本研究旨在评估现实资源限制条件下，不同系统治疗序贯方案在晚期HCC中的实际治疗模式与生存结局。 方法：本回顾性研究在泰国南部某三级医疗中心开展。系统回顾了2010年至2024年间接受系统治疗的晚期HCC患者（n=330）的医疗记录。研究终点包括总生存期（OS）、无进展生存期（PFS）和客观缓解率（ORR），并对OS的预后因素进行了分析。 结果：一线治疗方案包括酪氨酸激酶抑制剂（TKI；69.7%）、化疗（23.3%）、免疫治疗（IO）/靶向治疗（3.6%）、双免疫治疗（1.8%）及单药免疫治疗（1.5%）。各队列的中位OS、PFS和ORR分别为：7.2、5.2、10.9、8.5和8.6个月；3.94、3.22、3.48、6.19和2.69个月；以及9.6%、10.4%、16.7%、0%和20.0%。随着治疗线数增加，OS呈现改善趋势（接受一至四线治疗者的OS分别为4.5、12.2、19.4和40.7个月）。门静脉癌栓、腹水、胆红素水平升高、甲胎蛋白高水平和东部肿瘤协作组体能状态评分较差与不良预后相关；而多线治疗和超重状态与OS改善相关。 结论：在这项大规模真实世界队列研究中，由于基于IO的治疗方案可及性有限，TKI仍是主要的有效治疗选择。序贯系统治疗显著改善了生存结局，这凸显了保持治疗适应症和多学科团队协作的重要性。在资源有限的环境中，化疗可被视为可行的治疗选择。
肿瘤(癌症)患者之家