Karasuyama Takuma, Ishii Takamichi, Yoh Tomoaki, Ogiso Satoshi, Takeda Haruhiko, Takai Atsushi, Kishi Noriko, Shimizu Hironori, Ito Takashi, Haga Hironori, Hatano Etsuro
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Ann Surg Oncol. 2025 Mar;32(3):1819-1820. doi: 10.1245/s10434-024-16622-w. Epub 2024 Dec 13.
Hepatocellular carcinoma (HCC) with inferior vena cava (IVC) tumor thrombus is generally considered to be borderline resectable because of its poor prognosis. This report describes a patient who underwent multidisciplinary treatment for HCC with massive IVC tumor thrombus.
The 56-year-old woman in this study had diffuse HCC of the medial and anterior segments. She received an explanation of the procedure and provided informed consent. A tumor thrombus was observed in the right atrium through the middle and left hepatic veins and in the anterior branch of the portal vein. The HCC was considered unresectable, and atezolizumab plus bevacizumab combination therapy was initiated. However, the tumor thrombus progressed to the right atrium after two courses. The treatment was changed to hepatic arterial infusion chemotherapy with cisplatin and three-dimensional conformal radiotherapy to the tumor thrombus in the right atrium, followed by systemic lenvatinib.
The patient's tumor marker levels decreased significantly, and the tumor thrombus regressed into the IVC. Left hepatic trisegmentectomy and IVC tumor thrombectomy were performed. Although Clavien-Dindo IIIa postoperative biliary leakage was observed, the patient was discharged on postoperative day 56. Pathologic findings showed no viable residual tumor cells in either the main tumor or the tumor thrombus, and the patient had a pathologic complete response. At this writing, the patient has been recurrence-free for 19 months since the initial treatment without any adjuvant therapy.
This report presents a case of unresectable HCC treated with multimodality therapy followed by salvage surgery. The patient achieved a long-term cancer-free and drug-free status through aggressive treatment. This patient's experience offers hope for aggressive treatment of advanced HCC.
肝细胞癌（HCC）合并下腔静脉（IVC）肿瘤血栓通常因其预后较差而被认为是边缘可切除的。本报告描述了一名接受多学科治疗的HCC合并大量IVC肿瘤血栓患者。
本研究中的56岁女性患有肝中叶和肝前叶弥漫性HCC。她接受了手术过程的解释并签署了知情同意书。通过肝中静脉和肝左静脉以及门静脉前支在右心房观察到肿瘤血栓。该HCC被认为无法切除，遂开始使用阿替利珠单抗联合贝伐单抗进行联合治疗。然而，两个疗程后肿瘤血栓进展至右心房。治疗改为顺铂肝动脉灌注化疗并对右心房肿瘤血栓进行三维适形放疗，随后进行全身乐伐替尼治疗。
患者的肿瘤标志物水平显著下降，肿瘤血栓退缩至IVC。进行了左半肝三叶切除术和IVC肿瘤血栓切除术。尽管术后观察到Clavien-Dindo IIIa级胆漏，但患者在术后第56天出院。病理结果显示主肿瘤和肿瘤血栓中均无存活的残留肿瘤细胞，患者达到病理完全缓解。撰写本文时，自初始治疗以来，该患者在未接受任何辅助治疗的情况下已无复发19个月。
本报告介绍了一例不可切除HCC经多模式治疗后行挽救性手术的病例。患者通过积极治疗实现了长期无癌且无药状态。该患者的经历为晚期HCC的积极治疗带来了希望。
