目的 探讨立体定向放疗联合信迪利单抗和贝伐珠单抗治疗不可切除肝癌的效果、安全性及预后指标。 方法 选取2022年3月—12月在中国人民解放军总医院第五医学中心放射治疗科接受立体定向放疗联合信迪利单抗和贝伐珠单抗类似物（双达方案）治疗的42例不可切除原发性肝癌患者，给予计划靶区处方剂量为36～50 Gy，分5～6次，连续照射，后序贯双达方案治疗，每3周为1个疗程，直至出现肿瘤进展或严重不良反应。采用Kaplan-Meier法计算总生存率和无进展生存率，并采用Log-rank检验进行比较；Cox比例风险模型分析影响预后的相关因素。 结果 中位随访时间为21.6个月，客观缓解率为69%，疾病控制率为85.7%，中位无进展生存期为10.0个月（95%CI：6.7～13.0），中位总生存期为23.3个月（95%CI：14.7～31.8）。不良反应多为1～2级，未发生致命性不良反应。治疗后6～8周AFP应答组中位总生存期显著优于AFP未应答组（未达到 vs 11.8个月，P=0.007）。多因素分析显示AFP应答与患者良好的预后相关（HR=0.31，95%CI：0.13～0.75，P=0.009）。 结论 对于不可切除肝癌患者，立体定向放疗联合双达方案可改善患者生存且安全性可控，治疗后6～8周AFP水平下降>50%可作为潜在预后指标。

Objective To investigate the efficacy and safety of stereotactic body radiotherapy （SBRT） combined with sintilimab and bevacizumab in the treatment of patients with unresectable hepatocellular carcinoma （uHCC） and related prognostic factors. Methods A total of 42 patients with uHCC who underwent SBRT combined with sintilimab and bevacizumab in Department of Radiation Oncology， The Fifth Medical Centre of PLA General Hospital， from March to December 2022 were enrolled. The prescribed dose of planning target volume was 36‍ ‍—‍ ‍50 Gy in 5‍ ‍—‍ ‍6 fractions for continuous irradiation， followed by the regimen of sintilimab and bevacizumab. Each course of treatment was 3 weeks until the presence of tumor progression or serious adverse events. The Kaplan-Meier method was used to calculate overall survival （OS） rate and progression-free survival （PFS） rate， and the log-rank test was used for comparison between groups； the Cox proportional hazards model was used to investigate the influencing factors for prognosis. Results The median follow-up time was 21.6 months， with an objective response rate of 69%， a disease control rate of 85.7%， a median PFS of 10.0 months （95% confidence interval ［CI］： 6.7‍ ‍—‍ ‍13.0）， and a median OS of 23.3 months （95%CI： 14.7‍ ‍—‍ ‍31.8）. Most adverse events were grade 1‍ ‍—‍ ‍2 events， and there were no fatal adverse events. At 6‍ ‍—‍ ‍8 weeks after treatment， the AFP response group had a significantly better OS than the non-AFP response group （not reached vs 11.8 months， P=0.007）. The multivariate analysis showed that AFP response was associated with the good prognosis of patients （hazard ratio=0.31， 95%CI： 0.13‍ ‍—‍ ‍0.75， P=0.009）. Conclusion For patients with uHCC， SBRT combined with sintilimab and bevacizumab can improve survival with a manageable safety profile， and a >50% reduction in AFP at 6‍ ‍—‍ ‍8 weeks after treatment can be used as a potential prognostic indicator.