Abstract: Background Integrated traditional Chinese and Western medicine treatment can effectively relieve symptoms，inhibit tumor metastasis，and prolong survival in patients with hepatocellular carcinoma（HCC）. In recent years，with the development of evidence-based medicine，the definite efficacy of traditional Chinese medicine in HCC treatment urgently requires support from real-world clinical data. Objective To investigate the survival characteristics of patients with advanced HCC and explore the survival benefit of integrated traditional Chinese and Western medicine treatment for HCC patients. Methods Clinical data of 291 patients with advanced HCC were collected. These patients either were hospitalized in Hubei Provincial Hospital of Traditional Chinese Medicine from December 2014 to May 2022，or visited the same hospital and were enrolled in the "Bidirectional Cohort Study of Primary Liver Cancer" from August 2023 to December 2024. Patients were divided into two groups according to treatment regimens：the Western medicine treatment group（167 cases） and the integrated traditional Chinese and Western medicine treatment group（124 cases）. Propensity Score Matching（PSM） was performed using the nearest neighbor method at a 1∶1 ratio with a caliper value of 0.05 to screen patients. Kaplan-Meier survival curves were plotted to compare differences in 3-year survival and overall survival between the two groups receiving different treatments. A Cox proportional hazards regression model was used to analyze factors influencing the survival of HCC patients. Results A total of 210 HCC patients were successfully matched，with 105 cases in each of the Western medicine treatment group and the integrated treatment group. Among them，there were 168 males（80.0%） and 42 females（20.0），with a mean age of（57.7±0.8） years. After matching，there were no statistically significant differences between the two groups in terms of gender，age，place of residence，smoking history，drinking history，presence of viral hepatitis，liver cirrhosis，diabetes，hypertension，or BCLC stage（P>0.05）. By the end of follow-up，166（79.0%） of the 210 patients had died and 44（21.0%） were still alive，with a median survival time of 17.29 months（95%CI=13.554-21.032）. The 1-year，3-year，and 5-year cumulative survival rates were 51.4%，20.9%，and 7.3% in the Western medicine treatment group，and 69.8%，31.7%，and 10.9% in the integrated treatment group，respectively. Statistically significant differences were observed between the two groups in 3-year survival and survival by the end of follow-up（χ2 =6.068，P=0.014; χ2 =5.171，P=0.023）. Results of the multivariate Cox regression model showed that compared with the Western medicine treatment group，the integrated traditional Chinese and Western medicine treatment reduced the survival risk of patients with advanced HCC（HR=0.642，95%CI=0.467-0.882，P=0.006）.Conclusion Traditional Chinese medicine combined with local tumor treatment and/or targeted/immunotherapy can prolong the survival time and improve the survival rate of patients with advanced HCC.

Key words: Features　HCC, Advanced Stage, Hubei Province, Integrated Traditional Chinese and Western Medicine（ITCM-WM） Treatment, Cohort Study, Propensity Score Matching, Cox Regression

摘要： 背景 中西医结合治疗可有效缓解肝细胞癌（HCC）患者症状、抑制肿瘤转移并延长其生命。近年来随着循证医学的发展，中医药治疗肝癌的确切疗效亟需真实世界临床数据支撑。目的 了解中晚期HCC患者的生存特征，探索中西医结合治疗中晚期 HCC 患者的生存期获益。方法 收集2014年12月—2022年5月在湖北省中医院住院治疗及2023年8月—2024年12月就诊于湖北省中医院并入组“原发性肝癌双向队列研究”的291例中晚期HCC患者的临床资料，根据治疗方案将患者分为西医治疗组（167例）和中西医结合治疗组（124例）。采用最邻近匹配法按1∶1比例和0.05卡钳值进行倾向性评分匹配（PSM）筛选患者；绘制Kaplan-Meier生存曲线，比较接受不同治疗方式的两组HCC患者3年生存期及总生存期差异；采用Cox风险比例回归模型分析HCC患者生存期的影响因素。结果 成功匹配210例HCC患者，其中西医治疗组和中西医结合治疗组各105例，男168例（80.0%），女42例（20.0%），平均年龄（57.7±0.8）岁；匹配后两组性别、年龄、居住地、吸烟史、饮酒史、是否病毒性肝炎、肝硬化、糖尿病、高血压、巴塞罗那（BCLC）分期比较，差异无统计学意义（P>0.05）；至随访结束，210 例患者中死亡 166 例（79.0%），存活44例（21.0%），中位生存时间17.29（95%CI=13.554~21.032）个月；2组1、3、5年累积生存率分别为西医治疗组：51.4%、20.9%、7.3%，中西医结合治疗组：69.8%、31.7%、10.9%；2组的3年生存期和至随访结束生存期比较，差异均有统计学意义（χ2 =6.068，P=0.014；χ2 =5.171，P=0.023）。多因素Cox回归模型分析结果显示：中西医结合治疗中晚期HCC患者相对于西医治疗组的生存风险降低（HR=0.642，95%CI=0.467~0.882，P=0.006）。结论 中医药联合肿瘤局部治疗和（或）靶向/免疫治疗能延长中晚期HCC患者的生存期，提高生存率。

关键词: 肝细胞癌, 中晚期, 湖北省, 中西医结合治疗, 队列研究, 倾向性评分匹配, Cox 回归