本研究旨在比较在肝细胞癌（HCC）患者中，放射治疗（RT）加上PD-1 programmed cell death protein 1的抗体（anti-PD1）与单纯放射治疗对放射性肝毒性（RIHT）的影响，评估非经典放射性肝病（ncRILD）的预后因素，并建立一个预测ncRILD概率的图谱。我们回顾性地纳入接受RT加上PD1（RT + PD1，n = 30）或单纯RT（n = 66）治疗的不能手术的HCC患者。每组中的30名患者通过倾向性评分匹配（PSM）被放置在一个匹配队列中。治疗相关的肝毒性在PSM前后进行评估和分析。通过单变量逻辑回归分析和Spearman等级检验来确定影响ncRILD的预测因素，在匹配组中生成一个图谱。在PSM前，除了门冬氨酸氨基转移酶（AST）≥ 1级和总胆红素≥ 1级增加以外，两组之间在RIHT方面没有差异。经PSM后，AST≥ 1级在RT + PD1组中发生的频率更高（p = 0.020），而两组之间在其他肝毒性指标方面没有显著差异。在匹配组中，V25，肿瘤数量，年龄和凝血酶原时间（PT）是ncRILD建模的最佳预后因素。图谱显示了很好的预测性能（曲线下面积= 0.82）。HCC患者在接受RT + PD1治疗后的RIHT发生率与仅RT治疗相当。基于V25，肿瘤数量，年龄和PT的图谱可以可靠地预测ncRILD的概率。© 2023. BioMed Central Ltd.，Springer Nature的一部分。

In this study, we aimed to compare the radiation-induced hepatic toxicity (RIHT) outcomes of radiotherapy (RT) plus antibodies against programmed cell death protein 1 (anti-PD1) versus RT alone in patients with hepatocellular carcinoma (HCC), evaluate prognostic factors of non-classic radiation-induced liver disease (ncRILD), and establish a nomogram for predicting the probability of ncRILD.Patients with unresectable HCC treated with RT and anti-PD1 (RT + PD1, n = 30) or RT alone (n = 66) were enrolled retrospectively. Patients (n = 30) in each group were placed in a matched cohort using propensity score matching (PSM). Treatment-related hepatotoxicity was evaluated and analyzed before and after PSM. The prognostic factors affecting ncRILD were identified by univariable logistic analysis and Spearman's rank test in the matched cohort to generate a nomogram.There were no differences in RIHT except for increased aspartate aminotransferase (AST) ≥ grade 1 and increased total bilirubin ≥ grade 1 between the two groups before PSM. After PSM, AST ≥ grade 1 occurred more frequently in the RT + PD1 group (p = 0.020), and there were no significant differences in other hepatotoxicity metrics between the two groups. In the matched cohort, V25, tumor number, age, and prothrombin time (PT) were the optimal prognostic factors for ncRILD modeling. A nomogram revealed a good predictive performance (area under the curve = 0.82).The incidence of RIHT in patients with HCC treated with RT + PD1 was acceptable and similar to that of RT treatment. The nomogram based on V25, tumor number, age, and PT robustly predicted the probability of ncRILD.© 2023. BioMed Central Ltd., part of Springer Nature.