Kodai Shintaro, Kanazawa Akishige, Kinoshita Masahiko, Hamano Genya, Nishio Kohei, Murata Akihiro, Shimizu Sadatoshi, Kikuchi Takuya, Yonemitsu Ken, Shirai Daisuke, Nobori Chihoko, Tashima Tetsuzo, Goto Wataru, Miura Kotaro, Maeda Kiyoshi
Dept. of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital.
Gan To Kagaku Ryoho. 2020 Mar;47(3):502-504.
A 76-year-old man was referred to our hospital for advanced hepatocellular carcinoma(HCC)with chronic hepatitis type B. Although he underwent right anterior sectionectomy and S3 segmentectomy, multiple recurrences were found in the hepatic remnant after 2 months. Transcatheter arterial chemoembolization(TACE)and transcatheter arterial infusion (TAI)were performed separately. One and a half month after the last TAI, AFP and PIVKA-Ⅱ levels markedly elevated, and multiple early enhancing nodules with portal vein tumor thrombosis were detected on CT. A half dose of sorafenib(400mg/ day)was administered to the patient who was refractory to TACE. Sorafenib was discontinued after 4 weeks because the patient developed general fatigue and anorexia(Grade 3). Furthermore, these adverse events became worse, and ascites appeared. He was hospitalized in the palliative care unit for best supportive care for 3 weeks and also received outpatient treatment for more than 14 months. Fifteen months after discontinuing sorafenib administration, his condition improved dramatically, and CT revealed that the multiple HCC had reduced in size. Moreover, the portal vein tumor thrombosis disappeared. As his performance status and liver function were well preserved, he underwent partial hepatectomy for residual HCC. The patient remains alive without recurrence at 18 months, despite no administration of sorafenib.
This case demonstrates that sorafenib administration combined with surgical treatment could possibly cure advanced HCC refractory to TACE.
一名76岁男性因晚期肝细胞癌（HCC）合并慢性乙型肝炎被转诊至我院。尽管他接受了右前叶切除术和S3段切除术，但术后2个月肝残余组织中发现多处复发。分别进行了经动脉化疗栓塞术（TACE）和经动脉灌注术（TAI）。最后一次TAI术后1个半月，甲胎蛋白（AFP）和异常凝血酶原（PIVKA-Ⅱ）水平显著升高，CT检查发现多个早期强化结节并伴有门静脉癌栓。对TACE治疗无效的患者给予半量索拉非尼（400mg/天）治疗。4周后因患者出现全身乏力和厌食（3级）而停用索拉非尼。此外，这些不良事件加重，出现腹水。他在姑息治疗病房住院3周接受最佳支持治疗，并接受门诊治疗超过14个月。停用索拉非尼15个月后，他的病情显著改善，CT显示多个肝癌病灶缩小。此外，门静脉癌栓消失。由于其体能状态和肝功能保存良好，他接受了残余肝癌的部分肝切除术。尽管未使用索拉非尼，患者在18个月时仍存活且无复发。
本病例表明，索拉非尼治疗联合手术治疗可能治愈对TACE难治的晚期HCC。
