Song Wen-Jie, Xu Jian, Nie Ye, Li Wei-Min, Li Jian-Ping, Yang Li, Wei Meng-Qi, Tao Kai-Shan
Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China.
Department of Radiotherapy, The First Affiliated Hospital of the Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
World J Clin Cases. 2024 Jun 6;12(16):2847-2855. doi: 10.12998/wjcc.v12.i16.2847.
The prognosis of hepatocellular carcinoma (HCC) combined with portal and hepatic vein cancerous thrombosis is poor, for unresectable patients the combination of targeted therapy and immune therapy was the first-line recommended treatment for advanced HCC, with a median survival time of only about 2.7-6 months. In this case report, we present the case of a patient with portal and hepatic vein cancerous thrombosis who achieved pathologic complete response after conversion therapy.
In our center, a patient with giant HCC combined with portal vein tumor thrombus and hepatic vein tumor thrombus was treated with transcatheter arterial chemoembolization (TACE), radiotherapy, targeted therapy and immunotherapy, and was continuously given icaritin soft capsules for oral regulation. After 7 months of conversion therapy, the patient's tumor shrank and the tumor thrombus subsided significantly. The pathology of surgical resection was in complete remission, and there was no progression in the postoperative follow-up for 7 months, which provided a basis for the future strategy of combined conversion therapy.
In this case, atezolizumab, bevacizumab, icaritin soft capsules combined with radiotherapy and TACE had a good effect. For patients with hepatocellular carcinoma combined with hepatic vein/inferior vena cava tumor thrombus, adopting a high-intensity, multimodal proactive strategy under the guidance of multidisciplinary team (MDT) is an important attempt to break through the current treatment dilemma.
肝细胞癌（HCC）合并门静脉和肝静脉癌栓的预后较差，对于不可切除的患者，靶向治疗与免疫治疗联合是晚期HCC的一线推荐治疗方案，中位生存时间仅约2.7 - 6个月。在本病例报告中，我们介绍了1例门静脉和肝静脉癌栓患者在转化治疗后实现病理完全缓解的病例。
在我们中心，1例巨大HCC合并门静脉瘤栓和肝静脉瘤栓的患者接受了经动脉化疗栓塞术（TACE）、放疗、靶向治疗和免疫治疗，并持续口服给予淫羊藿素软胶囊进行调理。经过7个月的转化治疗，患者肿瘤缩小，瘤栓明显消退。手术切除病理完全缓解，术后7个月随访无进展，为未来联合转化治疗策略提供了依据。
本病例中，阿替利珠单抗、贝伐珠单抗、淫羊藿素软胶囊联合放疗和TACE取得了良好疗效。对于合并肝静脉/下腔静脉瘤栓的肝细胞癌患者，在多学科团队（MDT）指导下采用高强度、多模式的积极策略是突破当前治疗困境的重要尝试。
