Gon Hidetoshi, Kido Masahiro, Fukumoto Takumi, Takebe Atsushi, Tanaka Motofumi, Kuramitsu Kaori, Kinoshita Hisoka, Fukushima Kenji, Urade Takeshi, So Shinichi, Shinzeki Makoto, Matsumoto Ippei, Ajiki Tetsuo, Ku Yonson
Dept. of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University, Graduate School of Medicine.
Gan To Kagaku Ryoho. 2015 Sep;42(9):1111-4.
A 38-year-old man underwent right hepatectomy for a huge hepatocellular carcinoma(HCC)in the right hepatic lobe. Four months later, recurrent and metastatic disease were observed in the remnant liver and right lung, respectively. We performed a hepatectomy for the recurrent lesion because transcatheter arterial chemoembolization (TACE) was not effective. After surgery, we initiated sorafenib treatment for the lung metastases. One year later, the lung metastases worsened and metastases were observed in the mediastinal lymph nodes, and both metastatic lesions were resected. Seven months later, para-aortic lymph nodal metastasis was observed and dissected. Three months later, metastasis to the supraclavicular lymph node was observed. We performed particle radiation therapy and a complete response was achieved. One year later, metastases in both lungs were observed and resected. Despite continued sorafenib administration throughout the clinical course, a metastasis to the left adrenal gland was observed. This lesion was extirpated because no other recurrent lesions were detected. At 4 years and 6 months after the first operation, no other recurrences have occurred. Currently, sorafenib is the initial drug of choice for HCC with extrahepatic metastases. It is possible to improve the prognosis of patients with HCC and extrahepatic metastases by applying surgical treatment during the course of sorafenib administration.
一名38岁男性因右肝叶巨大肝细胞癌接受了右肝切除术。四个月后，分别在残余肝脏和右肺观察到复发和转移病灶。由于经动脉化疗栓塞术（TACE）无效，我们对复发病灶进行了肝切除术。术后，我们开始对肺转移灶进行索拉非尼治疗。一年后，肺转移灶恶化，纵隔淋巴结出现转移，两处转移病灶均被切除。七个月后，观察到主动脉旁淋巴结转移并进行了清扫。三个月后，发现锁骨上淋巴结转移。我们进行了粒子放射治疗并取得了完全缓解。一年后，观察到双肺转移并进行了切除。尽管在整个临床过程中持续给予索拉非尼，但仍观察到左肾上腺转移。由于未检测到其他复发病灶，该病灶被切除。首次手术后4年6个月，未出现其他复发情况。目前，索拉非尼是伴有肝外转移的肝细胞癌的首选初始药物。在索拉非尼给药过程中应用手术治疗有可能改善伴有肝外转移的肝细胞癌患者的预后。
