Kim Yongkook, Hata Tomoki, Tanizaki Keiko, Okano Miho, Kawada Junji, Okuyama Masaki, Yamasaki Masaru, Murakami Masahiro, Shimizu Junzou, Miwa Hideaki, Imamoto Haruhiko, Tsujinaka Toshimasa
Dept. of Surgery, Kaizuka City Hospital.
Gan To Kagaku Ryoho. 2019 Feb;46(2):360-362.
We report a case of liver metastasis of intrahepatic cholangiocarcinoma that achieved clinical complete response after gemcitabine(GEM)and cisplatin(CDDP)combination chemotherapy. The patient was a 69-year-old man who was diagnosed with intrahepatic cholangiocarcinoma with hilar invasion and intrahepatic metastasis(cT4N0M0, Stage ⅣA)and was initially treated with right trisegmentectomy with left portal vein resection, lymph node dissection, and reconstruction of the left portal vein and biliary tract after transhepatic portal vein embolization(PTPE). S-1 was administered continuously as postoperative adjuvant chemotherapy, and the patient showed no signs of recurrence. Three years after the surgery, a CT scan showed LDA 10mm in diameter in the middle area of the remnant liver. We suspected liver metastasis when both serum CA19-9 and DUPAN-2 levels were elevated with the increasing size of LDA; liver biopsy was then performed, and he was diagnosed with liver metastasis of intrahepatic cholangiocarcinoma. After 3 courses of combination chemotherapy containing GEM and CDDP, a CT scan revealed that the liver metastasis reduced in size, and PR was achieved based on the RECIST standard. After 12 courses, the liver metastasis disappeared, and the patient had achieved CR based on the RECIST standard. The patient has received S-1 following the combination chemotherapy and survived for 6 years since initial treatment without any other metastatic lesions.
我们报告一例肝内胆管癌肝转移患者,其在吉西他滨(GEM)和顺铂(CDDP)联合化疗后达到临床完全缓解。患者为69岁男性,被诊断为肝内胆管癌伴肝门侵犯和肝内转移(cT4N0M0,ⅣA期),最初接受了右三叶切除加左门静脉切除、淋巴结清扫,并在经肝门静脉栓塞(PTPE)后进行了左门静脉和胆道重建。术后持续给予S-1作为辅助化疗,患者未出现复发迹象。手术后三年,CT扫描显示残余肝中部有一个直径10mm的低密度影(LDA)。当血清CA19-9和DUPAN-2水平随LDA增大而升高时,我们怀疑发生了肝转移;随后进行了肝活检,他被诊断为肝内胆管癌肝转移。在进行了3个疗程含GEM和CDDP的联合化疗后,CT扫描显示肝转移灶缩小,根据实体瘤疗效评价标准(RECIST)达到部分缓解(PR)。12个疗程后,肝转移灶消失,根据RECIST标准患者达到完全缓解(CR)。联合化疗后患者接受了S-1治疗,自初始治疗以来已存活6年,未出现任何其他转移病灶。