转化治疗联合蔡氏ALPPS治疗晚期肝细胞癌1例报告

Conversion therapy combined with CAI’s ALPPS for advanced hepatocellular carcinoma: A case report

肝细胞癌(HCC)是我国最常见的恶性肿瘤之一,目前手术治疗仍然是肝癌的首要治疗手段。但我国70%~80%的HCC病人初诊时已为中晚期,失去了手术机会。近年来,随着HCC系统治疗ORR的显著提升,越来越多的初始不可手术病人获得了手术机会,实现了成功的转化治疗,病人近期肿瘤学疗效得以明显改善。该病例通过采取肝动脉持续灌注化疗(HAIC)联合仑伐替尼靶向治疗和特瑞普利单克隆抗体免疫治疗对不可切除的肝癌病人进行转化治疗,进一步综合评估后发现病人剩余肝体积不足,采用蔡氏ALPPS治疗,病人术后第5天顺利出院。2个月后复查,肿瘤无复发转移征象。该病例转化治疗充分利用局部与系统治疗的联合,手术治疗灵活运用团队的改良创新技术,获得了满意的近期疗效,目前仍在持续随访中,病人有望继续获得更长的生存获益,以真实世界临床初探为HCC转化治疗研究提供了一定参考。

Hepatocellular carcinoma(HCC)is one of the most common malignant tumors in China,and surgical intervention is the primary treatment for HCC patient.However,for the patients diagnosed with unresectable advanced HCC,conversion therapy followed by surgical treatment may be effective.In this case,the patient with unresectable advanced HCC was given hepatic artery infusion chemotherapy(HAIC),targeted therapy with lenvatinib and immunotherapy with teriprizumab for conversion therapy.Further evaluation indicated insufficient future liver remnant for this patient,thus we decided to perform the Cai’s ALPPS for him.After the operation,the patient got quick recovery of the liver function and was discharged on postoperative day(POD)5.The 2 month fellow-up examination showed no tumor recurrence or metastasis.Conversion therapy followed by ALPPS increases the resection rate of advanced HCC,and it is important to choose appropriate patient group for conversion treatment,optimal conversion treatment and evaluation plan,and suitable postoperative adjuvant therapy.