Bertacco Alessandra, Vitale Alessandro, Mescoli Claudia, Cillo Umberto
Department of Surgery, Oncology & Gastroenterology, Hepatobiliary Surgery & Liver Transplant Unit, Padua University, Padua, Italy.
Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy.
Per Med. 2020 Mar;17(2):83-87. doi: 10.2217/pme-2018-0114. Epub 2020 Mar 11.
Sorafenib is acknowledged as the standard therapy for advanced hepatocellular carcinoma (HCC) but in the clinical practice the treatment of these patients is extremely complex and needs to be personalized. New evidence suggests that surgical resection-based multimodal treatments may improve outcome in these patients. There is no strong evidence supporting the ability of sorafenib in downstage HCC before surgery. We presented a case of a 53-year-old man with well-compensated HCV-cirrhosis complicated with HCC and neoplastic portal vein thrombosis. The patient was treated initially with sorafenib with optimal radiological and serological response and subsequently with liver resection. Pathological examination showed necrotic portal thrombosis and massive necrosis of a metastatic regional node confirming radiological evidence. This finding suggests that sorafenib exhibits a potential to downstage advanced HCC which is not irrelevant. A possible combination of different modalities has to be considered in the view of a personalized medicine.
索拉非尼被公认为晚期肝细胞癌（HCC）的标准治疗方法，但在临床实践中，这些患者的治疗极其复杂，需要个性化。新证据表明，基于手术切除的多模式治疗可能会改善这些患者的预后。没有强有力的证据支持索拉非尼在术前使HCC降期的能力。我们报告了一例53岁男性患者，患有代偿良好的丙型肝炎肝硬化，合并HCC和肿瘤性门静脉血栓形成。该患者最初接受索拉非尼治疗，取得了最佳的影像学和血清学反应，随后接受了肝切除术。病理检查显示坏死性门静脉血栓形成和转移性区域淋巴结大量坏死，证实了影像学证据。这一发现表明，索拉非尼具有使晚期HCC降期的潜力，这并非无关紧要。鉴于个性化医疗，必须考虑不同治疗方式的可能组合。
