探讨初始不可切除肝细胞癌（肝癌）患者靶向免疫联合治疗后手术切除临床疗效。

回顾性分析2021年1月至2022年10月南通大学附属南通第三医院收治的5例中晚期不可切除肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男4例，女1例；年龄50～63岁，中位年龄57岁。肝癌CNLC分期Ⅲa期1例，Ⅲb期1例，Ⅱb期3例，对初始不可切除肝癌行仑伐替尼联合替雷利珠单抗治疗后再手术。分析手术方式、术后并发症、肿瘤坏死率及预后。

患者靶向免疫联合治疗3～8周期，治疗过程中患者平稳耐受，有1～2级不良反应，无明显不适。疗效确切，肿瘤部分缓解或完全缓解，达到预期手术指征。5例患者均转化成功并进行手术治疗，其中左半肝切除1例，右半肝切除1例，部分肝切除3例，肿瘤坏死率分别为100%、30%、85%、60%、70%，切缘阴性者4例。随访时间4～20个月，中位随访时间16个月；随访期间无复发，5例患者生存状态良好。

对于初始不可切除肝癌患者，靶向免疫联合治疗安全、有效，转化治疗可有机会实现根治性切除目的，延长患者的生存期。

To evaluate clinical efficacy of surgical resection after targeted immunotherapy in patients with initially unresectable hepatocellular carcinoma (HCC).

Clinical data of 5 patients with intermediate-stage and advanced unresectable HCC admitted to Nantong Third People's Hospital Affiliated to Nantong University from January 2021 to October 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 4 patients were male and 1 female, aged from 50 to 63 years, with a median age of 57 years. According to the China liver cancer (CNLC) staging system, 1 case was classified asCNLC-Ⅲa, 1 case as CNLC-Ⅲb, and 3 cases as CNLC-Ⅱb. Surgical resection was performed after treating with lenvatinib combined with tislelizumab in patients with initially unresectable HCC. Surgical methods, postoperative complications, tumor necrosis rate and prognosis were analyzed.

A total of3-8 cycles of targeted immunotherapy were delivered. During the treatment, all patients were stable and tolerant, presenting with grade 1-2 adverse reactions and no significant discomfort. Definite clinical efficacy was achieved. Partial remission (PR) or complete remission (CR) of the tumors was obtained. Expected surgical indications were achieved. All 5 patients successfully received conversion therapy followed by surgical resection, including 1 case of left hepatectomy, 1 case of right hepatectomy and 3 cases of partial hepatectomy, respectively. The tumor necrosis rates were 100%, 30%, 85%, 60% and 70%, respectively. Negative surgical margins were observed in 4 cases. The follow-up time was ranged from 4 to 20 months,with a median time of 16 months. During postoperative follow-up, no recurrence was reported,5 patients were physically stable and no patient died.

Targeted immunotherapy is safe and efficacious for patients with initially unresectable HCC. Conversion therapy may achieve radical resection and prolong the survival of patients.