Chen Kang, Luo Cheng-Piao, Ge De-Xiang, Wang Ke-Lin, Luo Qin, Li Yan-Zhi, You Xue-Mei, Xiang Bang-De, Li Le-Qun, Ma Liang, Zhong Jian-Hong
Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China.
Pathology Department, Guangxi Medical University Cancer Hospital, Nanning, China.
Front Oncol. 2022 Oct 6;12:946693. doi: 10.3389/fonc.2022.946693. eCollection 2022.
Most patients with hepatocellular carcinoma (HCC) are diagnosed when the disease is already at an advanced stage, so they are not eligible for resection and their prognosis is poor. The combination of transarterial chemoembolization (TACE) with immune checkpoint inhibitors or tyrosine kinase inhibitors can improve unresectable HCC to the point that patients can be treated with surgery. Here we describe two cases of such "conversion therapy". One patient was a 52-year-old man in Child-Pugh class A with treatment-naive HCC whose 11.3-cm tumor had invaded the middle hepatic vein and right branch of the portal vein. He was treated with TACE plus camrelizumab, and radical resection was performed 3 months later. No evidence of recurrence was observed during 5-month follow-up. The other patient was a 42-year-old man in Child-Pugh class A with HCC involving a 11.4-cm tumor and severe liver cirrhosis. The patient was treated with TACE and lenvatinib, but the embolic effect after one month was unsatisfactory, so the regional treatment was changed to hepatic artery infusion chemotherapy and transcatheter arterial embolization. Radical resection was performed 2 months later, and no recurrence was evident at 1-month follow-up. These cases demonstrate two conversion therapies that may allow patients with initially unresectable HCC to benefit from resection.
大多数肝细胞癌（HCC）患者在疾病已处于晚期时才被诊断出来，因此他们不符合手术切除条件，预后较差。经动脉化疗栓塞术（TACE）与免疫检查点抑制剂或酪氨酸激酶抑制剂联合使用可使不可切除的HCC病情得到改善，达到患者可接受手术治疗的程度。在此，我们描述两例这种“转化治疗”的病例。一例患者是一名52岁男性，Child-Pugh A级，初治HCC，其11.3厘米的肿瘤已侵犯肝中静脉和门静脉右支。他接受了TACE加卡瑞利珠单抗治疗，3个月后进行了根治性切除。在5个月的随访期间未观察到复发迹象。另一例患者是一名42岁男性，Child-Pugh A级，HCC，肿瘤大小为11.4厘米，伴有严重肝硬化。该患者接受了TACE和仑伐替尼治疗，但1个月后的栓塞效果不理想，因此将局部治疗改为肝动脉灌注化疗和经导管动脉栓塞术。2个月后进行了根治性切除，1个月随访时未发现复发。这些病例展示了两种转化治疗方法，可使最初不可切除的HCC患者从手术切除中获益。
