Treatment of hepatocellular carcinoma with hepatic vein tumor thrombosis protruding into the inferior vena cava by conversion surgery following chemotherapy with regorafenib: a case report
Treatment of hepatocellular carcinoma with hepatic vein tumor thrombosis protruding into the inferior vena cava by conversion surgery following chemotherapy with regorafenib: a case report
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DOI：
10.1007/s12328-019-01077-4
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发表时间：
2020-01-22
影响因子：
1
通讯作者：
Endo, Itaru
中科院分区：
文献类型：
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作者：
Takeda, Kazuhisa;Tsurumaru, Yuji;Endo, Itaru
瑞戈非尼是一种口服多激酶抑制剂，影响血管生成、肿瘤发生、转移和肿瘤免疫。作为一种全身性治疗，它已被证明为索拉非尼治疗进展的肝细胞癌（HCC）患者提供生存获益。我们在本文中报告了一例肝静脉肿瘤血栓形成突入下腔静脉（IVC-HVTT）的肝癌病例，在接受瑞戈非尼二线化疗后通过手术成功治疗。一位79岁的慢性肝炎患者被诊断为肝癌。计算机断层扫描显示在第7和第8段有一个孤立的肿瘤，右肝静脉有一个IVC-HVTT。由于IVC-HVTT切除是一项困难的手术，因此肿瘤被诊断为不可切除，并开始索拉非尼给药。5周后，病变的大小增加了15.3%;随后，给予瑞格非尼作为二线治疗12个月。IVC-HVTT缩小后，患者被转诊至我院接受手术。停用瑞戈非尼后1个月，在未使用全肝血管阻断的情况下，成功进行了第8节段的扩大切除和IVC-HVTT的全切除。无严重术后并发症。此外，自初始治疗以来约2年没有复发。
Regorafenib is an oral multikinase inhibitor affecting angiogenesis, oncogenesis, metastasis, and tumor immunity. As a systemic treatment, it has been shown to provide survival benefits in hepatocellular carcinoma (HCC) patients progressing on sorafenib treatment. We report herein a case of HCC with hepatic vein tumor thrombosis protruding into the inferior vena cava (IVC-HVTT) which was successfully treated by surgery following second-line chemotherapy with regorafenib. A 79-year-old man with chronic hepatitis was diagnosed with HCC. Computed tomography revealed a solitary tumor in segments 7 and 8 and an IVC-HVTT from the right hepatic vein. Since IVC-HVTT removal is a difficult procedure, the tumor was diagnosed as unresectable, and administration of sorafenib was started. Five weeks later, the lesion had increased in size by 15.3%; subsequently, regorafenib was given as second-line therapy for 12 months. After shrinkage of the IVC-HVTT, the patient was referred to our hospital for surgery. One month after the cessation of regorafenib, an extended resection of segment 8 and total removal of the IVC-HVTT was successfully performed without using total hepatic vascular exclusion. There were no serious postoperative complications. Additionally, there has been no recurrence for about 2 years since the initial therapy.