[1]吴浩东,刘宸佑,姜 楠,等.血糖水平对TACE联合靶向免疫药物治疗中晚期肝癌患者预后的影响[J].介入放射学杂志,2026,(09):1044-1049.[doi:10.3969/j.issn.1008-794X.2026.09.013]
　WU Haodong,LIU Chenyou,JIANG Nan,et al.The influence of blood glucose level on the prognosis of patients with intermediate-advanced hepatocellular carcinoma treated with TACE plus targeted and immunological therapy[J].J Intervent Med,2026,(09):1044-1049.[doi:10.3969/j.issn.1008-794X.2026.09.013]
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血糖水平对TACE联合靶向免疫药物治疗中晚期肝癌患者预后的影响()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2026年09
页码:
1044-1049
栏目:
临床研究
出版日期:
2026-09-10

文章信息/Info

Title:
The influence of blood glucose level on the prognosis of patients with intermediate-advanced hepatocellular carcinoma treated with TACE plus targeted and immunological therapy
文章编号:
1008-794X(2026)-009-1044-06
作者:
吴浩东;  刘宸佑;  姜 楠;  陈睿喆;  李婉慈;  张 帅;  朱晓黎;  沈 健
215006 江苏苏州 苏州大学附属第一医院介入科
Author(s):
WU Haodong; LIU Chenyou; JIANG Nan; CHEN Ruizhe; LI Wanci; ZHANG Shuai; ZHU Xiaoli; SHEN Jian.
Department of Interventional Radiology,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215006,China
关键词:
肝细胞癌;  高血糖;  经动脉化疗栓塞;  免疫治疗;  靶向治疗;  联合治疗
分类号:
R735.7
DOI:
10.3969/j.issn.1008-794X.2026.09.013
文献标志码:
B
摘要:
目的 探讨空腹血糖水平对接受经动脉化疗栓塞(TACE)联合PD-1/PD-L1抑制剂和分子靶向药物治疗的中晚期肝细胞癌(HCC)患者预后的影响。方法 回顾性分析2019年5月至2024年3月苏州大学附属第一医院行TACE联合靶免治疗的中晚期HCC患者临床资料,按照治疗前空腹血糖水平分为高血糖组和正常血糖组。采用Kaplan-Meier法绘制生存曲线,Log-Rank方法评估组间差异。比较两组的中位无进展生存期(mPFS)、中位总生存期(mOS)。根据mRECIST标准评估客观反应,比较两组的客观缓解率(ORR)、疾病控制率(DCR)。采用Cox比例风险回归分析中晚期HCC患者预后的影响因素。对比两组患者的不良反应发生率。结果 共纳入115例HCC患者,其中高血糖组42例,正常血糖组73例。高血糖组和正常血糖组的mPFS分别为9.2个月(95%CI:5.15～13.35)和12.7个月(95%CI:9.76～15.64),差异有统计学意义(P=0.039); 高血糖组和正常血糖组的mOS分别为14.1个月(95%CI:10.71～17.49)和26.1个月(95%CI:19.76～32.44),差异有统计学意义(P=0.010)。多因素Cox比例风险回归分析结果显示,高血糖、ALBI高评分与肿瘤数目大于3个是影响HCC患者远期预后的独立危险因素。高血糖组和正常血糖组的ORR分别为40.48%和61.64%,差异有统计学意义(P=0.028),DCR分别为78.57%和84.93%,差异无统计学意义(P=0.386)。除了高血糖组免疫治疗后发热的风险更高(P=0.021)外,两组治疗相关不良反应发生率差异均无统计学意义(均P>0.05)。结论 高血糖水平是影响接受TACE联合PD-1/PD-L1抑制剂和分子靶向药物治疗的中晚期HCC患者预后的不利因素。

参考文献/References:

[1] Han B,Zheng R,Zeng H,et al.Cancer incidence and mortality in China,2022[J].J Natl Cancer Cent,2024,4:47-53.
[2]Yan R,Sun M,Yang H,et al.2024 latest report on hepatitis B virus epidemiology in China:current status,changing trajectory,and challenges[J].Hepatobiliary Surg Nutr,2025,14:66-77.
[3]Hosokawa T,Kurosaki M,Tsuchiya K,et al.Hyperglycemia is a significant prognostic factor of hepatocellular carcinoma after curative therapy[J].World J Gastroenterol,2013,19:249-257.
[4]Mao X,Cheung KS,Tan JT,et al.Glycaemic control is a modifiable risk factor for hepatocellular carcinoma and liver-related mortality in patients with diabetes[J].Aliment Pharmacol Ther,2024,60:1398-1408.
[5]Li X,Wang X,Gao P.Diabetes mellitus and risk of hepatocellular carcinoma[J].Biomed Res Int,2017,2017:5202684.
[6]Lin J,Rao D,Zhang M,et al.Metabolic reprogramming in the tumor microenvironment of liver cancer[J].J Hematol Oncol,2024,17:6.
[7]中国抗癌协会肿瘤内分泌专业委员会,重庆市中西医结合学会肿瘤内分泌分会.肿瘤相关性高血糖管理指南(2021年版)[J].中国癌症杂志,2021,31:651-688.
Onco-endocrinology Society of Chinese Anti-Cancer Association,Onco-endocrinology Committee of Chongqing Association of Integrative Medicine.Guidelines for management of tumor-associated hyperglycemia(2021 edition)[J].China Oncology,2021,31:651-688.
[8]肖书萍,万 青,肖 芳,等.肝细胞癌合并糖尿病经动脉化疗栓塞治疗围手术期血糖管理专家共识[J].临床放射学杂志,2024,43:162-169.
Xiao SP,Wan Q,Xiao F,et al.Expert Consensus on Perioperative Blood Glucose Management for Patients with Hepatocellular Carcinoma and Diabetes Mellitus Undergoing Transarterial Chemoembolization[J].Journal of Clinical Radiology,2024,43:162-169.
[9]Braia N,Streba CT,Alexandru DO,et al.Hepatocellular carcinoma in diabetic patients-a single center experience[J].Curr Health Sci J,2016,42:180-187.
[10]Kim K,Choi S,Park SM.Association of fasting serum glucose level and type 2 diabetes with hepatocellular carcinoma in men with chronic hepatitis B infection:a large cohort study[J].Eur J Cancer,2018,102:103-113.
[11]Dai J,Zhu X,Shen J,et al.The effect of metabolic syndrome on the outcome of hepatitis B-associated hepatocellular carcinoma patients after hepatectomy:a multicenter study[J].Front Oncol,2022,12:811084.
[12]Feng YH,Lin CY,Huang WT,et al.Diabetes mellitus impairs the response to intra-arterial chemotherapy in hepatocellular carcinoma[J].Med Oncol,2011,28:1080-1088.
[13]黄高峰,庞志刚,贾华磊.糖尿病对巴塞罗那临床肝癌分期B期原发性肝细胞癌患者经肝动脉化疗栓塞术后预后的影响研究[J].中国全科医学,2016,19:2010-2014.
Huang GF,Pang ZG,Jia HL.Influence of diabetes on the prognosis of patients with Barcelona clinic liver cancer stage B HCC after transcatheter arterial chemoembolization[J].Chinese General Practice,2016,19:2010-2014.
[14]Liu SR,Chao R,Liang P,et al.Diabetes mellitus may worsen the prognosis in hepatocellular carcinoma patients undergoing curative microwave ablation[J].J BUON,2018,23:958-964.
[15]Wu KC,Lee IC,Liu CA,et al.Diabetes mellitus negatively impacts outcomes of HBV-Related hepatocellular carcinoma following thermal ablation[J].J Hepatocell Carcinoma,2024,11:2257-2267.
[16]Liu G,Xia F,Fan G,et al.Type 2 diabetes mellitus worsens the prognosis of intermediate-stage hepatocellular carcinoma after transarterial chemoembolization[J].Diabetes Res Clin Pract,2020,169:108375.
[17]Moon SJ,Ahn CH,Lee YB,et al.Impact of hyperglycemia on complication and mortality after transarterial chemoembolization for hepatocellular carcinoma[J].Diabetes Metab J,2024,48:302-311.
[18]王 琪,张 玉,王芳芳,等.原发性肝癌肝动脉化疗栓塞术后医院感染病原菌及其影响因素[J].中华医院感染学杂志,2023,33:2634-2638.
Wang Q,Zhang Y,Wang FF,et al.Pathogens isolated from primary liver caner patients with nosocomial infection after transhepatic arterial chemotherapy and embolization and influencing factors[J].Chin J Nosocomiol,2023,33:2634-2638.
[19]吕素珍,黄旭芳,毛剑婷,等.强化血糖管理在肝癌合并糖尿病患者射频消融围手术期的应用研究[J].介入放射学杂志,2019,28:582-585.
Lv SZ,Huang XF,Mao JT,et al.Application of intensive blood glucose management in HCC patients associated with diabetes during perioperative period of radiofrequency ablation[J].J Interv Radiol,2019,28:582-585.
[20]王凯民.肝动脉化疗栓塞治疗原发性肝癌合并糖尿病的疗效分析[J].糖尿病新世界,2020,23:18-19.
Wang KM.The effect of TACE in the treatment of primary liver cancer with diabetes mellitus[J].Diabetes New World,2020,23:18-19.
[21]Sangro B,Kudo M,Erinjeri JP,et al.Durvalumab with or without bevacizumab with transarterial chemoembolisation in hepatocellular carcinoma(EMERALD-1):a multiregional,randomised,double-blind,placebo-controlled,phase 3 study[J].Lancet,2025,405:216-232.
[22]Kudo M,Ren Z,Guo Y,et al.Transarterial chemoembolisation combined with lenvatinib plus pembrolizumab versus dual placebo for unresectable,non-metastatic hepatocellular carcinoma(LEAP-012):a multicentre,randomised,double-blind,phase 3 study[J].Lancet,2025,405:203-215.
[23]刘光华,俞炬明,范国平,等.肝细胞癌患者伴发糖尿病行肝动脉化疗栓塞术的预后因素分析[J].介入放射学杂志,2017,26:926-930.
Liu GH,Yu JM,Fan GP,et al.Analysis of prognostic factors in patients with hepatocellular carcinoma complicated by diabetes mellitus after transcatheter arterial chemoembolization[J].J Interv Radiol,2017,26:926-930
[24]Lei S,Yang J,Chen C,et al.FLIP(L)is critical for aerobic glycolysis in hepatocellular carcinoma[J].J Exp Clin Cancer Res,2016,35:79.
[25]Zhang Y,Li W,Bian Y,et al.Multifaceted roles of aerobic glycolysis and oxidative phosphorylation in hepatocellular carcinoma[J].Peer J,2023,11:e14797.
[26]Chen HL,OuYang HY,Le Y,et al.Aberrant MCT4 and GLUT1 expression is correlated with early recurrence and poor prognosis of hepatocellular carcinoma after hepatectomy[J].Cancer Med,2018,7:5339-5350.
[27]Stuver SO,Kuper H,Tzonou A,et al.Insulin-like growth factor 1 in hepatocellular carcinoma and metastatic liver cancer in men[J].Int J Cancer,2000,87:118-121.
[28]Tovar V,Cornella H,Moeini A,et al.Tumour initiating cells and IGF/FGF signalling contribute to sorafenib resistance in hepatocellular carcinoma[J].Gut,2017,66:530-540.
[29]Li W,Liu H,Qian W,et al.Hyperglycemia aggravates microenvironment hypoxia and promotes the metastatic ability of pancreatic cancer[J].Comput Struct Biotechnol J,2018,16:479-487.
[30]Du L,Xu H,Fang L,et al.Albumin-bilirubin score as a predictor of all-cause mortality in patients with hepatitis B virus infection:an analysis of National Health and Nutrition Examination Survey(NHANES)1999-2018[J].Prev Med Rep,2024,39:102639.
[31]Pinato DJ,Sharma R,Allara E,et al.The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma[J].J Hepatol,2017,66:338-346.
[32]赵首捷,杨振宇,雷世雄,等.Child-Pugh评分和ALBI分级对BCLC-B期肝癌生存预后预测价值比较[J].中华肝脏外科手术学电子杂志,2021,10:38-42.
Zhao SJ,Yang ZY,Lei SX,et al.Comparison of prognostic value between Child-Pugh score and albumin-bilirubin grading for patients with BCLC-B stage hepatocellular carcinoma[J].Chin J Hepat Surg(Electronic Edition),2021,10:38-42.
(收稿日期:2025-06-24)
(本文编辑:新 宇)

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[9]黄渊全,贾中芝,冯耀良,等.CT灌注成像在肝癌TACE术后疗效评价中的应用价值[J].介入放射学杂志,2009,(06):437.
　HUANG Yuan-quan,JIA Zhong-zhi,FENG Yao-liang,et al.Clinical application of CT perfusion imaging in estimating the efficacy of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma[J].J Intervent Med,2009,(09):437.
[10]王惠文,刘瑞宝,刘　　　岩,等.原发性肝癌ＴＡＣＥ后ＦＡＫ、ＮＦκＢｐ６５表达及意义[J].介入放射学杂志,2011,(08):621.
　WANG Hui-wen,LIU Rui-bao,LIU Yan,et al.The expression and significance of FAK and NF-κBp65 in hepatocellular carcinoma after transcatheter arterial chemoembolization[J].J Intervent Med,2011,(09):621.

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更新日期/Last Update: 2026-09-25