2例肝癌综合降期治疗的MDT讨论

MDT discussion of comprehensive downstaging treatment for 2 cases of liver cancer

目的探讨多学科协作团队(MDT)讨论在肝癌综合降期治疗中的价值。方法回顾性分析西南医科大学附属医院收治的2例经MDT讨论后采取综合治疗成功降期的肝癌患者的临床资料。结果病例1入院时诊断为肝癌伴双肺广泛转移,临床分期为Ⅲb期,经MDT讨论予以经肝动脉及支气管动脉灌注化疗栓塞,同时联合阿帕替尼进行降期治疗,目前患者双肺转移瘤完全消失,临床分期降为Ⅱb期,拟行根治性手术切除。病例2入院时诊断为肝癌,临床分期为Ⅰb期,术前检查提示肝储备功能较差,无法耐受半肝切除,经MDT讨论予以经动脉化疗栓塞联合阿帕替尼进行降期,同时予以保肝治疗,临床分期降为Ⅰa期,肝储备功能改善,并行腹腔镜右半肝切除,出院后随访3个月未见复发及转移。结论以MDT模式为基础的肝癌综合降期治疗可为无法行一期根治性手术的肝癌患者带来更好的临床结局。

Objective To explore value of multidisciplinary team(MDT)discussion in comprehensive downstaging treatment of liver cancer.Method The clinical data of 2 patients with liver cancer who could not undergo the radical surgery admitted to the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.Results Case 1 was diagnosed as the liver cancer with extensive double lung metastasis at admission.The clinical stage was stageⅢb;After MDT discussion,the patient was treated with chemotherapy and embolization via hepatic artery and bronchial artery;At the same time,the patient was treated with apatinib;At present,the metastasis of both lungs disappeared completely;The clinical stage was stageⅡB,and the radical resection was proposed.Case 2 was diagnosed as the right liver cancer at admission.The clinical stage was stageⅠb.The preoperative examination showed that the hepatic reserve function was poor and the patient could not tolerate the half hepatectomy;After MDT discussion,the patient was treated with the combination of chemotherapy and embolization via the hepatic artery and apatinib in the same period;At the same time,the patient was treated with liver protection.The clinical stage was reduced to stageⅠa.The hepatic reserve function improved and the laparoscopic right hemihepatectomy was performed,no recurrence or metastasis was found after 3 months follow-up.Conclusion Comprehensive downstaging treatment based on MDT model could bring better clinical outcomes for patients with liver cancer who are unable to undergo one-stage radical surgery.