A case of conversion hepatectomy for huge hepatocellular carcinoma with adrenal metastasis and vascular invasion after atezolizumab-bevacizumab treatment
A case of conversion hepatectomy for huge hepatocellular carcinoma with adrenal metastasis and vascular invasion after atezolizumab-bevacizumab treatment
复制标题
DOI：
10.1007/s12328-022-01644-2
复制
发表时间：
2022-05-18
影响因子：
1
通讯作者：
Kakizaki, Satoru
中科院分区：
文献类型：
--
作者：
Hoshino, Takashi;Naganuma, Atsushi;Kakizaki, Satoru
我们在此报告一个巨大的肝癌合并肾上腺转移及血管侵犯的病例，在atezolizumab-bevacizumab治疗后，成功地以转换性肝切除术治疗。患者男，77岁，因胸痛入院。他有HCC治疗史;但是，患者根据自己的决定停止接受随访治疗。这一次，是他5年来第一次来到我院急诊科。右叶的肿瘤已经生长成一个肿块，并伴有肾上腺转移，直径为15厘米。它已经侵入了下腔静脉。选择Atezolizumab-贝伐珠单抗治疗HCC。在开始治疗前，他的肝功能得以保留（Child-Pugh A5）。他的甲胎蛋白（AFP）和脱-γ-羧基凝血酶原（DCP）水平分别为759.0 ng/mL和5，681 mAU/mL。Atezolizumab-贝伐珠单抗治疗导致肿瘤标志物水平和肿瘤染色显著降低。atezolizumab-贝伐珠单抗治疗9个疗程后，由于蛋白尿，难以继续贝伐珠单抗给药。因为肿瘤已经缩小，肿瘤标志物在正常范围内，我们决定进行转换肝切除术。肿瘤通过膈肌联合切除术完全切除，病理学分析显示atezolizumab-贝伐单抗治疗完全缓解。在组织学分析中没有存活的肿瘤细胞。在转换手术后3个月，患者情况良好，没有任何复发迹象。
We herein report a case of huge hepatocellular carcinoma (HCC) with adrenal metastasis and vascular invasion successfully treated by conversion hepatectomy after atezolizumab-bevacizumab treatment. A 77-year-old male patient with chest pain was admitted. He had a history of HCC treatment; however, the patient stopped receiving follow-up treatment based on his own decision. This time, he visited the emergency department of our hospital for the first time in 5 years. The tumor at the right lobe had grown into a lump with adrenal metastases and was 15 cm in diameter. It had invaded the inferior vena cava. Atezolizumab-bevacizumab treatment was selected for HCC treatment. Before starting treatment, his liver function was preserved (Child-Pugh A5). His alpha fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) levels were 759.0 ng/mL and 5,681 mAU/mL, respectively. Atezolizumab-bevacizumab treatment resulted in a marked decrease in tumor marker levels and tumor staining. After nine courses of atezolizumab-bevacizumab treatment, it became difficult to continue the administration of bevacizumab because of proteinuria. Because the tumor had decreased in size and the tumor markers were in the normal range, we decided to perform conversion hepatectomy. The tumor was completely removed by combined resection of the diaphragm, and pathological analyses showed a complete response to atezolizumab-bevacizumab treatment. No viable tumor cells remained on histological analyses. The patient is doing well without any signs of recurrence at 3 months after conversion surgery.