【摘要】 目的 探讨真实世界中以抗PD-1抗体为基础的疗法在晚期肝细胞癌治疗中的疗效、不良反应及可能影响疗效的因素。方法 收集55例接受以PD-1抗体为基础治疗的晚期肝细胞癌患者，回顾性分析其临床特点、疗效及不良反应，并进行随访。结果 客观有效率为21.8%，疾病控制率为76.4%。治疗过程中不良反应整体发生率为81.8%，其中3～4级不良反应发生率为14.5%，免疫相关不良反应发生率为58.2%，其中3～4级免疫相关不良反应发生率为3.6%，无治疗相关死亡。55例患者中位无进展生存期为5.0月（95%CI:3.9～6.1），中位生存期11.4月（95%CI:6.5～16.3）。应用抗PD-1抗体前患者肝功能Child-Pugh评分和体能状态ECOG评分是影响治疗有效率和生存时间的主要因素；多因素分析也表明治疗前患者的体能状态ECOG评分和肝功能Child-Pugh评分是影响患者生存的独立预后因素（P<0.001, P=0.034）。结论 真实世界中以PD-1抗体为基础的治疗在晚期肝细胞肝癌患者中是安全有效的，其中治疗前患者的体能状态ECOG评分和肝功能Child-Pugh评分是影响患者生存期的独立预后因素。更多还原

【Abstract】 Objective To explore the efficacy, safety, and factors that might influence the efficacy of antiPD-1 antibody-based therapy in advanced hepatocellular carcinoma in the real world. Methods The clinical features, efficacy, and safety in patients with advanced hepatocellular carcinoma who received anti-PD-1antibody-based therapy were retrospectively analyzed. The survival status was followed-up. Results The objective response and the disease control rate were 21.8% and 76.4%, respectively. The overall incidence of adverse events during treatment was 81.8%, of which the incidence of grade 3/4 adverse events was 14.5%.The incidence of immune-related adverse events was 58.2% and the incidence of grade 3/4 immune-related adverse events was 3.6%, and no treatment-related death was observed. The median PFS of the 55 patients was 5.0(95%CI: 3.9-6.1) months, and the median OS was 11.4(95%CI: 6.5-16.3) months. Univariate and multivariate analyses showed that liver function Child-Pugh scores and performance status ECOG score were the influencing factors of the objective response rate and survival. Conclusion In the real world anti-PD-1antibody-based therapy is safe and effective in patients with advanced hepatocellular carcinoma, in which the performance status ECOG score and liver function Child-Pugh score before treatment are independent prognostic factors influencing survival.更多还原