阿特唑单抗联合贝伐单抗治疗肝细胞癌伴门静脉主干肿瘤血栓后的病理完全缓解

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2023-01-01 DOI:10.1159/000529405
Ken Kurisaki, Akihiko Soyama, Takanobu Hara, Hajime Matsushima, Hajime Imamura, Takayuki Tanaka, Tomohiko Adachi, Shinichiro Ito, Kengo Kanetaka, Masaaki Hidaka, Shinji Okano, Susumu Eguchi
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引用次数: 0

摘要

我们报告一个病例的病理完全缓解后成功治疗晚期肝细胞癌(HCC)合并门静脉肿瘤血栓阿特唑单抗和贝伐单抗根治性切除。患者是一名60多岁的男性。在慢性乙型肝炎的随访中,腹部超声检查显示肝脏右叶有一个巨大的肿瘤,肿瘤形成门静脉血栓。肿瘤血栓延伸至门静脉左支近端。患者肿瘤标志物水平升高(α -光蛋白,14,696 ng/mL;PIVKA-II, 2141 mAU/mL)。肝活检显示低分化HCC。根据BCLC分期系统,病变被归类为晚期。作为全身治疗,使用atezolizumab加贝伐单抗。化疗2个疗程后影像学显示肿瘤及门静脉血栓明显缩小,肿瘤标志物水平明显降低。经过3个疗程的化疗后,认为根治性切除是可能的。患者行右半肝切除术及门静脉取栓术。病理检查显示完全反应。总之,我们经历了一例晚期HCC采用atezolizumab + bevacizumab治疗的病例,这是一种全身治疗,目的是进行转换手术。
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Pathologic Complete Response after Chemotherapy with Atezolizumab plus Bevacizumab for Hepatocellular Carcinoma with Tumor Thrombus in the Main Portal Trunk.

We report a case of pathologic complete response after successful treatment for advanced hepatocellular carcinoma (HCC) complicated with portal venous tumor thrombus with atezolizumab and bevacizumab followed by radical resection. The patient was a male in his 60s. During follow-up for chronic hepatitis B, abdominal ultrasonography revealed a huge tumor located in the right lobe of the liver with the portal vein thrombosed by the tumor. The tumor thrombus extended to the proximal side of the left branch of the portal vein. The patient's tumor marker levels were elevated (alpha-phetoprotein, 14,696 ng/mL; PIVKA-II, 2,141 mAU/mL). Liver biopsy revealed poorly differentiated HCC. The lesion was categorized as advanced stage according to the BCLC staging system. As systemic therapy, atezolizumab plus bevacizumab was administered. Imaging showed marked shrinkage of the tumor and portal venous thrombus with a remarkable decrease of tumor marker levels after 2 courses of chemotherapy. After 3 additional courses of chemotherapy, radical resection was considered possible. The patient underwent right hemihepatectomy and portal venous thrombectomy. A pathological examination revealed a complete response. In conclusion, we experienced a case in which advanced HCC was curatively treated with atezolizumab plus bevacizumab, which was administered as systemic therapy with a view to conversion surgery.

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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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