探讨不可切除肝细胞癌（肝癌）患者转化治疗序贯手术的临床疗效及安全性。

回顾性分析2020年2月至2024年7月川北医学院附属医院收治的5例初始不可切除肝癌行转化治疗序贯手术切除患者的临床资料。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33~73岁，中位年龄53岁。5例均合并肝硬化；肝功能Child-Pugh分级A级4例，B级1例；东部肿瘤协作组-体能状态（ECOG-PS）评分均为0~1分。CNLC分期Ⅰb期2例，Ⅲa期3例。总结患者转化治疗、手术治疗情况，分析疗效及术后生存情况。

5例患者均采用以TACE为基础的局部治疗，联合免疫和靶向治疗。其中TACE+贝伐珠单抗+PD-1抑制剂方案1例，TACE+酪氨酸激酶抑制剂（TKIs）+PD-1抑制剂方案3例，TACE+TKIs+PD-1抑制剂+HAIC方案1例。术前转化治疗时间为138（109~311）d。5例患者均出现不同程度的不良反应，均为2级及以下不良反应，予对症处理后好转，无中断用药。手术时间为330（225~360） min，术中出血量为250（200~900） ml，住院时间20（15~27）d。术后病理学检查示切缘均为阴性，2例肿瘤细胞完全坏死，为病理学完全缓解（pCR），3例肿瘤部分坏死，为病理学部分缓解（pPR）；微血管侵犯分级M0级3例，M1级2例。随访时间3~44个月，中位随访时间27个月；1例术后21个月肝癌复发，消融治疗后未见复发或转移。其余4例均未见复发；随访时间内无死亡病例。

对于初始不可切除肝癌患者，TACE联合免疫和靶向治疗后手术切除可延长生存时间，但具体方案及疗效仍需大量前瞻性研究证明。

To evaluate clinical efficacy and safety of sequential surgery after conversion therapy in patients with unresectable hepatocellular carcinoma (HCC).

Clinical data of 5 patients with initially unresectable HCC who underwent sequential surgical resection following conversion therapy in Affiliated Hospital of North Sichuan Medical College from February 2020 to July 2024 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 33 to 73 years, with a median age of 53 years. All 5 cases were complicated with liver cirrhosis. 4 patients were assessed with Child-Pugh grade A and 1 case of Child-Pugh grade B liver function. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores were ranged from 0 to 1. According to the China Liver Cancer (CNLC) staging, 2 patients were classified with Ⅰb and 3 cases of Ⅲa stage tumor.The conversion therapeutic, operative regimen and effect, survival prognosis of the patients were summarized.

All 5 patients were treated with TACE-based local therapy combined with immunotherapy and targeted therapy. Among them, 1 case was treated with TACE+ bevacizumab + PD-1 inhibitor, 3 cases with TACE+TKIs+PD-1 inhibitor, and 1 case with TACE+TKIs+PD-1 inhibitor combined with HAIC. The duration of preoperative conversion therapy was 138 (109-311) d. All 5 patients had different degrees of adverse reactions, all of which were grade 2 or below. After symptomatic treatment, all the patients were alleviated without interruption of medication. The operation time was 330 (225-360) min, intraoperative blood loss was 250 (200-900) ml, and the length of hospital stay was 20 (15-27) d. Postoperative pathological results confirmed that resection margins were negative in all cases. Complete necrosis of tumor cells was found in 2 cases, who achieved pathological complete remission (pCR), and partial necrosis of tumor cells in 3 cases, who obtained pathological partial remission (pPR). For microvascular invasion (MVI) grade, 3 cases were with M0 and 2 with M1. Follow-up time was ranged from 3 to 44 months, with a median of 27 months. During the follow-up, 1 patient recurred at postoperative 21 months, and no recurrence or metastasis was observed after ablation treatment. No recurrence was observed in the remaining 4 cases. No death case was observed during the follow-up.

Surgical resection after TACE combined with immunotherapy and targeted therapy can prolong the survival time of patients with initially unresectable HCC. However, the specific regimen and efficacy remain to be validated by multiple prospective studies.