Yokoo Hideki, Takahashi Hiroyuki, Hagiwara Masahiro, Iwata Hiroyoshi, Imai Koji, Saito Yoshinori, Matsuno Naoto, Furukawa Hiroyuki
Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan.
Department of Gastroenterology, Asahikawa-Kosei General Hospital, Asahikawa 078-8211, Hokkaido, Japan.
World J Hepatol. 2020 Dec 27;12(12):1349-1357. doi: 10.4254/wjh.v12.i12.1349.
Lenvatinib has been shown to be noninferior to sorafenib regarding prognosis and recurrence rate in patients with unresectable hepatocellular carcinoma (HCC) who have not received prior systemic chemotherapy. In patients treated with lenvatinib, 40% of cases achieved sufficient tumor reduction to make potential surgery possible. However, the outcomes of such surgery are unknown. We report a successful case of hepatic resection for recurrent HCC after lenvatinib treatment.
A 69-year-old man underwent right anterior sectionectomy for HCC in segment 8 of the liver. Ten months later, he was found to have an intrahepatic HCC recurrence that grew rapidly to 10 cm in diameter with sternal bone metastases. After confirming partial response to lenvatinib administration for 2 mo, a second hepatectomy was performed. Pathological examination showed that 80% of the tumor was necrotic. The patient did not develop any adverse effects under lenvatinib treatment. He was discharged at 25 d after surgery. Radiation therapy for bone metastases continued to be given under lenvatinib, and the patient has remained alive for 1 year after the second hepatectomy.
The prognosis of patients with recurrent HCC may be improved by liver resection combined with prior lenvatinib therapy.
对于未接受过全身化疗的不可切除肝细胞癌（HCC）患者，在预后和复发率方面，乐伐替尼已被证明不劣于索拉非尼。在接受乐伐替尼治疗的患者中，40%的病例实现了足够的肿瘤缩小，使潜在的手术成为可能。然而，这种手术的结果尚不清楚。我们报告了一例乐伐替尼治疗后复发性HCC肝切除成功的病例。
一名69岁男性因肝8段HCC接受了右前叶切除术。10个月后，他被发现肝内HCC复发，迅速生长至直径10 cm，并伴有胸骨骨转移。在确认乐伐替尼给药2个月有部分缓解后，进行了第二次肝切除术。病理检查显示80%的肿瘤坏死。患者在乐伐替尼治疗期间未出现任何不良反应。术后25天出院。在乐伐替尼治疗下继续对骨转移进行放射治疗，第二次肝切除术后患者已存活1年。
复发性HCC患者的预后可能通过肝切除联合术前乐伐替尼治疗得到改善。
