呈现不可切除的肝细胞癌（uHCC）一线治疗的真实世界状况并探讨一线治疗的疗效和预后的预测因素。中国皖北4家医院接受一线治疗的uHCC患者的真实世界数据，对2019年7月至2022年12月期间的数据进行回顾性收集。分析临床病理特征、血液学指标，包括超氧化物歧化酶（SOD）和血管内皮生长因子-A（VEGF-A）、疗效和安全性数据。共入组153例患者，大部分患者接受靶向治疗联合化疗。免疫疗法（TI）。与接受 TI 治疗的患者相比，接受 TI 加局部治疗 (TIL) 的患者表现出更长的中位无进展生存期 (mPFS) 和中位总生存期 (mOS)（均 p<0.05），且安全性可控。此外，与基线血清SOD水平低的患者相比，基线血清SOD水平高的患者具有更好的治疗效果，并且具有更长的mPFS和mOS时间（均p<0.05）。亚组分析表明，低 SOD 水平的患者接受 TIL 时的 mPFS 时间比接受 TI 时更长 (p = 0.005)，但在高 SOD 水平的患者中，TIL 和 TI 之间的预后没有显着差异 (p > 0.05) 。此外，低 VEGF-A 组患者的 mOS 时间比高 VEGF-A 组患者更长（p = 0.004）。与TI相比，TIL可以改善高VEGF-A水平患者的生存时间，但不能改善低VEGF-A水平患者的生存时间。TI是uHCC患者最常用的一线全身治疗，在以下情况下具有更好的疗效和结局：与特定人群的局部治疗相结合。研究发现，基线血清 SOD 和 VEGF-A 是初级保健机构中 uHCC 患者决策、治疗反应和结果的潜在预测生物标志物。

To present the real-world status and explore the predictors of the efficacy and prognosis of first-line treatment for unresectable hepatocellular carcinoma (uHCC).Real-world data of uHCC patients who underwent first-line treatment at 4 hospitals in Northern Anhui, China, from July 2019 to December 2022 were retrospectively collected. The clinicopathological features, haematological indicators, including superoxide dismutase (SOD) and vascular endothelial growth factor-A (VEGF-A), efficacy and safety data were analysed.A total of 153 patients were enrolled and most of them treated with targeted therapy combined with immunotherapy (TI). Compared to patients treated with TI, patients who were administrated with TI plus locoregional therapy (TIL) showed longer median progression-free survival (mPFS) and median overall survival (mOS) times (both p < 0.05), with manageable safety profiles. Moreover, compared to patients with low baseline serum levels of SOD, patients with high baseline serum SOD levels had a better treatment efficacy and had longer mPFS and mOS times (all p < 0.05). Subgroup analyses indicated that patients with low SOD levels had longer mPFS times when receiving TIL than when receiving TI (p = 0.005), but, among patients with high SOD levels, their prognoses were not substantially different between TIL and TI (p > 0.05). Additionally, patients in the low-VEGF-A group had a longer mOS time than patients in the high-VEGF-A group (p = 0.004). In comparison with TI, TIL can improve the survival time among patients with high VEGF-A levels but not among patients with low VEGF-A levels.TI was the most commonly first-line systemic therapy for uHCC patients, with better efficacy and outcomes when combined with locoregional therapy in a certain population. Baseline serum SOD and VEGF-A were found to be potential predictive biomarkers for decision-making, treatment response, and outcome in patients with uHCC in the primary care setting.