Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan ; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Onco Targets Ther. 2014 May 27;7:829-34. doi: 10.2147/OTT.S61740. eCollection 2014.
The prognosis is usually poor in advanced hepatocellular carcinoma (HCC). Sorafenib is approved for Child-Pugh class A patients with unresectable and advanced HCC. We report here a rare case of a patient with advanced HCC with right portal vein thrombosis (PVT) who achieved a complete response after treatment with sorafenib. This 74-year-old man was a case of non-hepatitis B and C virus-related cirrhosis. Multiphase liver computed tomography showed an 8 cm tumor with early enhance, early wash out, and right PVT at segment 8 of the right lobe. A liver tumor biopsy confirmed the diagnosis of poorly differentiated HCC. Blood tests showed Child-Pugh class A cirrhosis and an alpha-fetoprotein level of 33,058 ng/mL. Sorafenib was initiated at 800 mg/day but was eventually reduced to 400 mg every other day because of a grade 3 hand-foot skin reaction. The alpha fetoprotein (AFP) level decreased rapidly with a linear trend after treatment. After log transformation, the calculated half-life of AFP was 6.84 days. There was no more tumor arterial enhancement, and tumor size was decreased to 3.7 cm on day 42. PVT shrank gradually and localized to the right anterior branch at month 9. There was no recurrence of tumor at the end of follow-up in month 19. Typical serial changes of clinical parameters were demonstrated in this patient.
晚期肝细胞癌（HCC）的预后通常较差。索拉非尼被批准用于不可切除和晚期 HCC 的 Child-Pugh 分级 A 患者。我们在此报告一例罕见的晚期 HCC 伴右门静脉血栓形成（PVT）患者，该患者在接受索拉非尼治疗后获得完全缓解。这名 74 岁男性患有非乙型和丙型肝炎病毒相关的肝硬化。多期肝脏计算机断层扫描显示 8cm 肿瘤，具有早期增强、早期洗脱和右叶 8 段的右 PVT。肝肿瘤活检证实为低分化 HCC。血液检查显示 Child-Pugh 分级 A 肝硬化和甲胎蛋白水平为 33058ng/ml。每天 800mg 开始使用索拉非尼，但由于 3 级手足皮肤反应，最终减少至每天 400mg。AFP 水平在治疗后迅速下降，呈线性趋势。经对数转换后，AFP 的半衰期计算为 6.84 天。肿瘤动脉增强消失，肿瘤大小在第 42 天缩小至 3.7cm。PVT 逐渐缩小并局限于第 9 个月的右前支。在第 19 个月的随访结束时，肿瘤无复发。该患者表现出典型的临床参数系列变化。
