Takahashi Kazuhiro, Kim Jaejeong, Takahashi Amane, Hashimoto Shinji, Doi Manami, Furuya Kinji, Hashimoto Ryosuke, Owada Yohei, Ogawa Koichi, Ohara Yusuke, Akashi Yoshimasa, Hisakura Katsuji, Enomoto Tsuyoshi, Shimomura Osamu, Noguchi Masayuki, Oda Tatsuya
Department of Gastrointestinal and Hepatobiliary Pancreatic Surgery, University of Tsukuba, Tsukuba 3058575, Ibaraki, Japan.
Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama 3620806, Saitama, Japan.
World J Hepatol. 2021 Mar 27;13(3):384-392. doi: 10.4254/wjh.v13.i3.384.
Hepatocellular carcinoma (HCC) accompanied by portal vein tumour thrombus (PVTT) presents an aggressive disease course, worsening liver function reserve, and a high recurrence rate. Clinical practice guidelines recommend systemic therapy as the first-line option for HCC with portal invasion. However, to achieve longer survival in these patients, the treatment strategy should be concluded with removal of the tumour by locoregional therapy. We experienced a case of initially unresectable HCC with main PVTT converted to radical hepatectomy after lenvatinib treatment.
A 59-year-old male with chronic hepatitis C infection visited our clinic as a regular post-surgery follow-up. Contrast-enhanced abdominal computed tomography revealed a liver mass diffusely located at the lateral segment with a massive PVTT extending from the umbilical portion to the main and contralateral third-order portal branches. With the diagnosis of unresectable HCC with Vp4 (main trunk/contralateral branch) PVTT, lenvatinib was started at 12 mg/d. The computed tomography taken 3 mo after starting lenvatinib showed regression of the PVTT, which had retreated to the contralateral first-order portal branch. He tolerated the full dose without major adverse effects. With cessation of lenvatinib for 7 d, radical left lobectomy and PVTT thrombectomy were conducted. The patient's postoperative course was uneventful. Microscopically, the primary lesion showed fibrotic changes, with moderately to poorly differentiated tumour cells surrounded by granulation tissues in some areas. The majority of the PVTT showed necrosis. He was alive without recurrence for 8 mo.
This is the first case of HCC with Vp4 PVTT in which radical conversion hepatectomy was succeeded after lenvatinib treatment.
伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）病程进展迅速，肝功能储备恶化，复发率高。临床实践指南推荐全身治疗作为门静脉侵犯性HCC的一线治疗选择。然而，为了使这些患者获得更长的生存期，治疗策略应以局部区域治疗切除肿瘤作为结束。我们遇到一例最初无法切除的伴有主要PVTT的HCC患者，在接受乐伐替尼治疗后成功进行了根治性肝切除术。
一名59岁慢性丙型肝炎感染男性患者因术后定期随访前来我院就诊。腹部增强计算机断层扫描显示肝脏肿块弥漫位于外侧段，有巨大的PVTT从脐部延伸至主门静脉和对侧三级门静脉分支。诊断为伴有Vp4（主干/对侧分支）PVTT的不可切除HCC，开始使用乐伐替尼，剂量为12mg/d。开始使用乐伐替尼3个月后进行的计算机断层扫描显示PVTT缩小，已退缩至对侧一级门静脉分支。他耐受了全剂量，无重大不良反应。停用乐伐替尼7天后，进行了根治性左肝叶切除术和PVTT血栓切除术。患者术后恢复顺利。显微镜下，原发灶显示纤维化改变，部分区域有中等至低分化肿瘤细胞被肉芽组织包绕。大多数PVTT显示坏死。他存活8个月无复发。
这是首例伴有Vp4 PVTT的HCC患者，在接受乐伐替尼治疗后成功进行了根治性转化肝切除术。
