Pathologic Complete Response after Chemotherapy with Atezolizumab plus Bevacizumab for Hepatocellular Carcinoma with Tumor Thrombus in the Main Portal Trunk
Pathologic Complete Response after Chemotherapy with Atezolizumab plus Bevacizumab for Hepatocellular Carcinoma with Tumor Thrombus in the Main Portal Trunk
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DOI：
10.1159/000529405
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发表时间：
2023-02
影响因子：
2.7
通讯作者：
Ken Kurisaki;A. Soyama;T. Hara;H. Matsushima;H. Imamura;Takayuki Tanaka;T. Adachi;S. Ito;K. Kanetaka;M. Hidaka;Shinji Okano;S. Eguchi
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作者：
Ken Kurisaki;A. Soyama;T. Hara;H. Matsushima;H. Imamura;Takayuki Tanaka;T. Adachi;S. Ito;K. Kanetaka;M. Hidaka;Shinji Okano;S. Eguchi
我们报告一例晚期肝细胞癌（HCC）合并门静脉癌栓的病例，在用atezolizumab和贝伐单抗成功治疗后，病理完全缓解，随后进行根治性切除。患者为60多岁的男性。在慢性B型肝炎的追踪中，腹部超音波检查发现一个位于肝右叶的巨大肿瘤，且肿瘤造成门静脉血栓形成。癌栓延伸至门静脉左分支近端。患者的肿瘤标志物水平升高（α-嗜铬蛋白，14，696 ng/mL; PIVKA-II，2，141 mAU/mL）。肝活检显示低分化肝癌。根据BCLC分期系统，病变被归类为晚期。作为全身治疗，给予atezolizumab+贝伐珠单抗。化疗2个疗程后，影像学显示肿瘤明显缩小，门静脉血栓形成，肿瘤标志物水平明显下降。经过3个疗程的化疗后，认为根治性切除是可能的。患者接受右半肝切除术和门静脉血栓切除术。病理学检查显示完全缓解。总之，我们经历了一例晚期HCC患者接受atezolizumab联合贝伐珠单抗治疗的病例，该治疗作为全身治疗，旨在进行转换手术。
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.