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肝细胞癌治疗已进入免疫联合治疗时代。双免疫疗法(如O+Y和STRIDE方案)基于关键Ⅲ期研究成为标准一线选择。其核心价值在于诱导深度且持久的免疫应答，带来显著的“拖尾效应”，使部分患者获得长期生存可能，并为存在抗血管生成治疗禁忌者提供“纯免疫”选项。然而，其疗效呈现异质性，且存在早期生存曲线交叉和与传统实体瘤疗效评价标准(Response Evaluation Criteria in Solid Tumours, RECIST)不匹配等挑战。临床决策需个体化权衡：对于需快速缩瘤(如伴门静脉癌栓)者，靶免联合治疗更具早期控制优势；对于追求长期生存、肝功能较差或存在特定禁忌者，双免疫疗法价值凸显。未来方向在于探索“双免+”联合策略和针对淋巴细胞活化基因3(lymphocyte activation gene-3, LAG-3)和T细胞免疫球蛋白黏蛋白分子3(T cell immunoglobulin and mucin domain-containing protein 3, TIM-3)等新靶点的药物，并利用生物标志物实现精准诊疗，推动治疗迈向“患者匹配”的新阶段。
Abstract：The treatment of hepatocellular carcinoma has entered the era of combination immunotherapy. Dual immune checkpoint blockade regimens such as O+Y and STRIDE regimens have become standard first-line options based on pivotal phase Ⅲ trials. Their core value lies in inducing deep and durable immune responses, generating a significant "tail effect" that offers the potential for long-term survival in some patients and provides an immunotherapy-only option for those with contraindications to antiangiogenic therapy. However, their efficacy remains heterogeneous and challenges persist, including the early crossing of survival curves and discordance with traditional Response Evaluation Criteria in Solid Tumors(RECIST). Clinical decision making requires personalized trade-offs: for patients requiring rapid tumor shrinkage(e.g., those with portal vein tumor thrombus), targeted therapy plus immunotherapy offers advantages in early disease control; for those prioritizing long-term survival, with poor liver function, or with specific contraindications, the value of dual immunotherapy becomes prominent. Future directions include exploring "dual immunotherapy-based" combination strategies and agents targeting novel checkpoints such as lymphocyte activation gene-3(LAG-3) and T cell immunoglobulin and mucin domain-containing protein 3(TIM-3), as well as utilizing biomarkers to enable precise diagnosis and treatment, and propel therapy toward a new era of "patient matching".
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基本信息:
DOI：10.13267/j.cnki.syzlzz.2026.018
引用信息:
[1]黄勇,郭莹,朱艳,等.肝细胞癌的双免治疗现状与进展[J],2026,41(2):119-127.DOI:10.13267/j.cnki.syzlzz.2026.018.