介入联合仑伐替尼桥接治疗超米兰标准肝癌肝移植2例报道

Transarterial chemoembolization combined with Lenvatinib bridging in the treatment of 2 patients with hepatocellular carcinoma exceeding Milan standard liver transplantation

目的探究超米兰标准肝癌肝移植术前肝癌降期或桥接治疗的新方案,评价介入联合仑伐替尼治疗超米兰标准肝癌后实施肝移植的安全性和疗效。方法回顾性分析我中心2例超米兰标准肝癌通过介入治疗联合仑伐替尼靶向治疗后成功接受肝移植患者的临床资料,术后规律复查血清学标记物、CT检查或肝脏彩超等评估患者的预后及肿瘤复发情况,评估该桥接方案的安全性和疗效。结果第一例患者为肝癌伴门静脉右前支癌栓,为我国肝癌分期(CNLC分期)Ⅲa期,通过介入联合仑伐替尼治疗2个月,患者接受同种异体原位肝移植术,术后切口愈合良好,痊愈出院,术后病理提示肿瘤绝大部分坏死,仅周围见少许异形细胞团,规律随访16个月,未见肿瘤复发。第二例患者为肝癌伴肝中静脉侵犯,为CNLC分期Ⅲa期,通过介入联合仑伐替尼治疗1个月,肿瘤学评价为SD,患者接受同种异体原位肝移植术,术后切口愈合良好,痊愈出院,术后病理提示绝大部分组织已坏死,仅见少量肿瘤细胞呈条索样、腺样排列,规律随访14个月,未见肿瘤复发。两例患者目前肝功能正常,无其他并发症发生。结论介入治疗联合仑伐替尼靶向治疗对晚期肝癌能较好的控制肿瘤进展,可作为超米兰标准肝癌肝移植前有效的桥接治疗手段,近期预后良好,对腹部切口的影响以及患者的中远期疗效需增加样本量并长期随访。

Objective To explore new plans for liver cancer down-staging or bridging therapy before ultra-Milan standard liver cancer transplantation,and to evaluate the safety and efficacy of Transarterial chemoembolization combined with Lenvatinib in the treatment of ultra-Milan standard liver cancer after liver transplantation.Methods Retrospective analysis was performed on the clinical data of 2 cases of patients with ultra-Milan standard liver cancer successfully bridged by liver transplantation after transarterial chemoembolization for treatment combined with targeted therapy of Lenvatinib in our center.The prognosis of the patients was evaluated by regular reexamination of serological markers,CT examination or liver color ultrasound,so as to evaluate the clinical possibility and usability of the new bridging protocol.Results The first patient for liver cancer with portal venous tumor emboli right branch of,for liver cancer stage(CNLC stage Ⅲa) in our country,after Transarterial chemoembolization combined with Lenvatinib bridging for 2 months,patients received liver transplantation,postoperative incision healed well,postoperative pathological suggest most tumor necrosis,only a few members of the heterocyst around the cell mass.Regular follow-up of 16 months,no tumor recurrence was observed.The Second patientwith liver cancer associated with liver vein invasion,as CNLC stage Ⅲa,after Transarterial chemoembolization combined with Lenvatinib bridging for one month,oncology evaluation for SD,patient received allogeneic orthotopic liver transplantation,postoperative incision healing is good.Postoperative pathology showed that most of the tissues were necrotic,and only a few tumor cells were arranged in cord like and adenoid.No recurrence of tumor was found in regular follow-up for 14 months.Both patients had normal liver function and no other complications occurred.Conclusion Transarterial chemoembolization for treatment combination with Lenvatinib can better control tumor progression in advanced liver cancer,and can be used as an effective bridging therapy for ultra-Milan standard liver cancer before liver transplantation.The short-term prognosis is good,and the influence on abdominal incision and the long-term efficacy of patients need to increase the sample size and long-term follow-up.