晚期肝细胞癌中西医临床协作专家共识（2026年版，云南）

云南省医院协会肝病专业委员会

doi:10.12449/JCH260907

晚期肝细胞癌中西医临床协作专家共识（2026年版，云南）

DOI: 10.12449/JCH260907

云南省医院协会肝病专业委员会

基金项目:

云南省重大疑难疾病中西医临床协作试点项目 (ZDYNJBZXYXTGG2024)

利益冲突声明：本文不存在任何利益冲突。

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出版历程
- 收稿日期: 2026-04-10
- 录用日期: 2026-05-06
- 出版日期: 2026-09-25

Expert consensus on integrated traditional Chinese and Western medicine clinical collaboration for advanced hepatocellular carcinoma (2026 edition, Yunnan, China)

Hepatology Committee of Yunnan Hospital Association

Research funding:

Yunnan Provincial Clinical Collaboration Pilot Project on Integrated Chinese and Western Medicine for Major and Intractable Diseases (ZDYNJBZXYXTGG2024)

摘要

摘要: 原发性肝癌是我国常见恶性肿瘤之一，其中肝细胞癌（HCC）占绝大多数。晚期HCC临床表现复杂，治疗手段多样，临床诊疗面临较大挑战。目前国内尚无专门针对晚期HCC的中西医临床协作共识。为规范晚期HCC的中西医协作诊疗流程，提升云南省晚期HCC诊疗的同质化水平，云南省医院协会肝病专业委员会组织消化内科、肝胆外科、介入科、肿瘤内科、放疗科、中医科、民族医学科、安宁疗护等多学科专家，基于当前最佳循证医学证据，结合云南省民族医药特色与临床实践，围绕晚期HCC的诊断、分期、系统治疗、局部治疗、抗病毒治疗、中医药及民族医药干预、多学科协作、质控管理及人文关怀等方面制定本共识。
- 癌，肝细胞 /
- 中西医结合 /
- 民族医药学 /
- 临终关怀医疗 /
- 共识
Abstract: Primary liver cancer is one of the most common malignancies in China， with hepatocellular carcinoma （HCC） accounting for the vast majority of these cases. Advanced HCC has complex clinical manifestations and diverse treatment modalities， posing great challenges to clinical diagnosis and treatment. Currently， there is still a lack of an expert consensus specifically focusing on integrated traditional Chinese and Western medicine clinical collaboration for advanced HCC in China. To standardize the diagnosis and treatment process of advanced HCC based on integrated traditional Chinese and Western medicine collaboration and improve the homogeneity of advanced HCC management in Yunnan Province， Hepatology Committee of Yunnan Hospital Association convened multidisciplinary experts from gastroenterology， hepatobiliary surgery， interventional radiology， medical oncology， radiation oncology， traditional Chinese medicine， ethnic medicine and hospice care to formulate this consensus based on the best evidence available and with reference to local ethnic medicine and clinical practice in Yunnan. This consensus covers various aspects of advanced HCC， including diagnosis， staging， systemic therapy， locoregional therapy， antiviral therapy， traditional Chinese medicine and ethnic medicine interventions， multidisciplinary collaboration， quality control， and humanistic care.
- Carcinoma， Hepatocellular /
- Integrated Traditional Chinese Medicine & Western Medicine /
- Minority Medicine /
- Hospice Care /
- Consensus

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表 1 晚期HCC系统治疗的适应证及治疗策略

Table 1. Indications and treatment strategies for systemic therapy in advanced HCC

适应证	一线治疗	二线治疗
CNLC Ⅲa期	阿替利珠单抗+贝伐珠单抗（1A）信迪利单抗+贝伐珠单抗（1A）阿帕替尼+卡瑞利珠单抗（1A）多纳非尼（1A）仑伐替尼（1A）替雷利珠单抗（1A）索拉非尼（1A）含奥沙利铂系统化疗（1A）（FOLFOX4等）度伐利尤单抗+替西木单抗（国外获批）	瑞戈非尼（1A）阿帕替尼（1A）雷莫西尤单抗（1A，AFP≥400 ng/mL）卡博替尼（国外获批）纳武利尤单抗+伊匹木单抗（国外获批）
CNLC Ⅲb期	同上一线方案	同上二线方案
TACE抵抗或治疗失败	转系统治疗，方案同上	根据一线用药选择未使用过的方案
肝功能Child-Pugh B级	慎用免疫联合方案，可考虑单药酪氨酸激酶抑制剂或最佳支持治疗	谨慎评估，优先对症支持
肝功能Child-Pugh C级	最佳支持治疗、对症处理，不推荐积极抗肿瘤治疗	—
注：①阿替利珠单抗联合贝伐珠单抗（IMbrave150研究）、信迪利单抗联合贝伐珠单抗类似物（ORIENT-32研究）、阿帕替尼联合卡瑞利珠单抗（RESCUE研究）的疗效均优于索拉非尼单药，目前已成为晚期HCC一线治疗的优先推荐方案。②度伐利尤单抗联合替西木单抗（“双免”方案，HIMALAYA研究）已获美国食品药品监督管理局及欧盟批准用于不可切除HCC的一线治疗，截至本共识制定时尚未在我国获批。③二线治疗药物的获批多基于索拉非尼或一线系统治疗失败后的临床研究数据；一线使用免疫联合方案后二线治疗的选择尚缺乏高级别循证证据支持，临床可根据患者具体情况选择已获批的二线药物或既往未使用过的一线药物。④纳武利尤单抗联合伊匹木单抗（CheckMate 040研究）及卡博替尼（CELESTIAL研究）已获美国食品药品监督管理局批准用于HCC二线治疗，目前在我国尚未获批。HCC，肝细胞癌；CNLC，中国肝癌分期；TACE，经导管动脉化疗栓塞术；Child-Pugh分级，蔡尔德-皮尤分级；AFP，甲胎蛋白。

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表 2 HCC抗肿瘤系统治疗方案用法用量及常见不良反应

Table 2. Dosage and common adverse reactions of anticancer systemic therapy regimens for HCC

药物/方案	剂量与用法	常见不良反应
阿替利珠单抗+贝伐珠单抗	阿替利珠单抗1 200 mg，静脉滴注；贝伐珠单抗15 mg/kg，静脉滴注；均每3周1次	高血压、蛋白尿、肝功能异常、腹泻、食欲下降、出血风险等
信迪利单抗+贝伐珠单抗类似物	信迪利单抗200 mg，静脉滴注；贝伐珠单抗类似物15 mg/kg，静脉滴注；均每3周1次	蛋白尿、血小板减少、AST升高、高血压、甲状腺功能减退等
阿帕替尼+卡瑞利珠单抗	阿帕替尼250 mg，口服，每日1次；卡瑞利珠单抗200 mg，静脉滴注，每2周1次	高血压、手足综合征、AST/ALT升高、反应性毛细血管增生症等
多纳非尼	200 mg，口服，每日2次，连续服用	手足皮肤反应、AST升高、总胆红素升高、血小板减少、腹泻等
仑伐替尼	体重<60 kg者8 mg，口服，每日1次；体重≥60 kg者12 mg，口服，每日1次	高血压、蛋白尿、腹泻、食欲下降、疲劳、手足综合征、甲状腺功能减退等
替雷利珠单抗	200 mg，静脉滴注，每3周1次	AST/ALT升高、总胆红素升高、皮疹、甲状腺功能减退等
索拉非尼	400 mg，口服，每日2次，连续服用	腹泻、手足综合征、皮疹、高血压、纳差、乏力等
FOLFOX4方案	奥沙利铂85～130 mg/m²，动脉灌注2～3 h；亚叶酸钙400 mg/m²或左亚叶酸钙200 mg/m²，动脉灌注1～2 h；5-氟尿嘧啶400 mg/m²静脉推注，后续2 400 mg/m² 持续动脉灌注23 h或 46 h；每3周重复1次，治疗间隔不宜超过4周	消化道反应、骨髓抑制、神经毒性等
瑞戈非尼	160 mg，口服，每日1次，第1～21天，每28天 1周期	高血压、手足综合征、乏力、腹泻、肝功能异常等
阿帕替尼单药	750 mg，口服，每日1次	高血压、蛋白尿、白细胞减少、血小板减少等
雷莫西尤单抗	8 mg/kg，静脉滴注，每2周1次	疲劳、外周水肿、高血压、食欲下降、低钠血症等
卡瑞利珠单抗单药	200 mg，静脉滴注，每2周1次	反应性毛细血管增生症、AST/ALT升高、甲状腺功能减退、乏力等
注：AST，天冬氨酸氨基转移酶；ALT，丙氨酸氨基转移酶；HCC，肝细胞癌。

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