Zheng Xiao-Qin, Sun Li-Bo, Jin Wen-Jie, Liu Hui, Song Wen-Yan, Xu Hui, Wu Ju-Shan, Wang Xiao-Jun, Gou Chun-Yan, Ding Hui-Guo
Integrated Traditional Chinese and Western Medicine Center, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.
Department of Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.
World J Gastrointest Surg. 2025 Jan 27;17(1):99752. doi: 10.4240/wjgs.v17.i1.99752.
Cirrhotic patients with super-giant hepatocellular carcinoma (HCC) and portal vein invasion generally have a poor prognosis. This paper presents a patient with super-giant HCC and portal vein invasion, who underwent hepatectomy followed by a combination of sorafenib and camrelizumab, resulting in complete remission (CR) for 5 years.
A 40-year-old male with compensated hepatitis B-related cirrhosis was diagnosed with HCC, Barcelona Clinic Liver Cancer stage C. Enhanced computed tomography imaging revealed a 152 mm × 171 mm tumor in the right liver, invading the portal vein and hepatic vein. Liver function was normal. The patient successfully underwent hepatectomy on July 18, 2019. However, by December 2019, HCC recurrence with lung metastases and portal vein invasion were detected. He started treatment with sorafenib (200 mg twice daily) and camrelizumab (200 mg every 3 weeks). By May 12, 2020, the patient was confirmed to have CR. Camrelizumab was adjusted to 200 mg every 12 weeks from June 16, 2021, with the last infusion on March 29, 2024. Although no further tumor recurrence was observed, he experienced two episodes of gastrointestinal bleeding due to esophagogastric varices, which were managed with endoscopic therapy. To date, the patient has remained in CR for 5 years.
The combination of hepatectomy with sorafenib and camrelizumab can achieve durable CR in patients with super-giant HCC and portal vein invasion. Further research is necessary to address these challenges and improve patient outcomes.
患有超大型肝细胞癌（HCC）且伴有门静脉侵犯的肝硬化患者预后通常较差。本文介绍了一名患有超大型HCC并伴有门静脉侵犯的患者，该患者接受了肝切除术后联合使用索拉非尼和卡瑞利珠单抗治疗，实现了5年的完全缓解（CR）。
一名40岁男性，患有代偿期乙型肝炎相关肝硬化，被诊断为HCC，巴塞罗那临床肝癌分期为C期。增强计算机断层扫描成像显示右肝有一个152毫米×171毫米的肿瘤，侵犯门静脉和肝静脉。肝功能正常。患者于2019年7月18日成功接受了肝切除术。然而，到2019年12月，检测到HCC复发并伴有肺转移和门静脉侵犯。他开始使用索拉非尼（每日两次，每次200毫克）和卡瑞利珠单抗（每3周200毫克）进行治疗。到2020年5月12日，患者被确认达到CR。自2021年6月16日起，卡瑞利珠单抗调整为每12周200毫克，最后一次输注时间为2024年3月29日。尽管未观察到进一步的肿瘤复发，但他因食管胃静脉曲张经历了两次胃肠道出血，通过内镜治疗进行了处理。迄今为止，该患者已保持CR状态5年。
肝切除术联合索拉非尼和卡瑞利珠单抗治疗可使超大型HCC并伴有门静脉侵犯的患者实现持久的CR。有必要进行进一步研究以应对这些挑战并改善患者预后。
