Conversion Hepatectomy for Huge Hepatocellular Carcinoma With Arterioportal Shunt After Chemoembolization and Lenvatinib Therapy
Conversion Hepatectomy for Huge Hepatocellular Carcinoma With Arterioportal Shunt After Chemoembolization and Lenvatinib Therapy
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DOI：
10.21873/anticanres.13768
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发表时间：
2019-10-01
影响因子：
2
通讯作者：
Akahoshi, Shinichi
中科院分区：
文献类型：
--
作者：
Sato, Nobutaka;Beppu, Toru;Akahoshi, Shinichi
肿瘤体积大和动门静脉分流是肝细胞癌的不良预后因素。乐伐替尼是日本开发的一种新型强效多酪氨酸激酶抑制剂。一名 66 岁女性患有肝细胞癌并患有未经治疗的丙型肝炎，被转诊至我们医院。她被判断为无法切除，并接受了四次经动脉化疗栓塞治疗；但由于存在大动脉门静脉分流，治疗效果并不理想。乐伐替尼连续给药4个月。此后，我们观察到肿瘤缩小，动脉门静脉分流完全消失，肝功能明显改善。成功完成治愈性肝切除术。极高水平的肿瘤标志物几乎恢复正常；治疗前甲胎蛋白水平为 1,008,021 ng/ml。初次治疗后 1 年，患者未出现复发。据我们所知，这是首例最初无法切除的肝细胞癌合并动脉门静脉分流患者，在接受包括乐伐替尼在内的多学科治疗后接受转换性肝切除术的病例。
Large tumor size and arterioportal shunt are poor prognostic factors for hepatocellular carcinoma. Lenvatinib is a novel and potent multi-tyrosine kinase inhibitor developed in Japan. A 66-year-old woman with hepatocellular carcinoma and untreated hepatitis C was referred to our hospital. She was judged as unresectable and was treated with four sessions of transarterial chemoembolization; however, the therapeutic effect was unsatisfactory because of major arterioportal shunt. Lenvatinib was sequentially administered for 4 months. Thereafter, we observed tumor shrinkage, complete disappearance of arterioportal shunt, and obvious improvement in liver function. A curative conversion hepatectomy was successfully accomplished. The extremely high levels of tumor markers almost normalized; the pretreatment levels were 1,008,021 ng/ml for alpha-fetoprotein. At 1 year after the primary treatment, the patient has not experienced recurrence. To our knowledge, this is the first case of a patient with initially unresectable hepatocellular carcinoma with arterioportal shunt who underwent conversion hepatectomy after multidisciplinary treatment, including lenvatinib.