Liu Sheng, Xiong Rui, Duan Chuanyi, Tang Jiang, Yin Tao, Dai Sisi
Department of Hepatobiliary Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Anaesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Front Oncol. 2023 Oct 5;13:1199143. doi: 10.3389/fonc.2023.1199143. eCollection 2023.
The prognosis of hepatocellular carcinoma combined with portal vein tumor thrombus is poor, with a median survival of only 3-6 months. PD-1 combined with targeted therapy may provide an opportunity for patients with BCLC C stage hepatocellular carcinoma combined with portal vein tumor thrombus to undergo radical surgery, significantly prolonging their survival time.
A middle-aged 51-year-old male who was diagnosed with hepatocellular carcinoma combined with portal vein main stem tumor thrombus at our center in May 2020, with a BCLC stage of C, liver cirrhosis, HBV infection, and preoperative evaluation as unresectable. The liver function was Child-Pugh A. The initial treatment was lenvatinib combined with PD-1 therapy, followed by one cycle of TACE treatment. The tumor and thrombus volume significantly reduced, followed by continuous TACE combined with immunotherapy and targeted therapy, leading to the appearance of portal vein main stem emboli. After multidisciplinary discussion, surgical resection was performed, and the embolus was removed, achieving a cure. The patient has been tumor-free for over 34 months.
PD-1 combined with lenvatinib and local TACE create conditions for radical surgery, and it is hoped that more real-world research data can provide better evidence for the transformational treatment of hepatocellular carcinoma combined with portal vein tumor thrombus.
肝细胞癌合并门静脉癌栓的预后较差，中位生存期仅3至6个月。程序性死亡受体1（PD-1）联合靶向治疗可能为巴塞罗那临床肝癌（BCLC）C期肝细胞癌合并门静脉癌栓患者提供根治性手术机会，显著延长其生存时间。
一名51岁中年男性，2020年5月在我院被诊断为肝细胞癌合并门静脉主干癌栓，BCLC分期为C期，有肝硬化、乙肝病毒感染，术前评估为不可切除。肝功能为Child-Pugh A级。初始治疗为乐伐替尼联合PD-1治疗，随后进行一个周期的经动脉化疗栓塞（TACE）治疗。肿瘤和栓子体积显著缩小，随后持续进行TACE联合免疫治疗和靶向治疗，导致门静脉主干栓子出现。经过多学科讨论后，进行了手术切除，取出栓子，实现了治愈。该患者已无瘤生存超过34个月。
PD-1联合乐伐替尼及局部TACE为根治性手术创造了条件，希望更多真实世界研究数据能为肝细胞癌合并门静脉癌栓的转化治疗提供更好的证据。
