一例肝细胞癌和卵巢癌双原发癌患者的MDT诊治报道

MDT diagnosis and treatment of a patient with double primary hepatocellular carcinoma and ovarian cancer

本文介绍1例初诊原发性肝癌和卵巢癌双原发癌患者的多学科团队(multidisciplinary team,MDT)诊疗过程。该患者肝脏和盆腔占位性质难以确定。第1次MDT讨论考虑盆腔占位为卵巢癌伴盆腔局部转移,但肝脏病灶性质未定,双原发肿瘤还是转移性癌?患者行肝脏病灶穿刺活检提示肝细胞癌。第2次MDT讨论认为肝脏肿瘤容易破裂出血,2个部位病灶可同时手术切除。患者同时接受肝脏肿瘤、卵巢、子宫及系膜切除术。术后病理检查示肝细胞癌和卵巢高级别浆液性癌。术后患者采用紫杉醇+卡铂方案联合贝伐珠单抗治疗。随访至今未见复发,患者生存已38个月。MDT诊疗模式有利于这种较为罕见的肝和卵巢双原发恶性肿瘤的诊断和治疗方案的确定,患者也因此获得较好生存。

This study reports the process of the multidisciplinary team(MDT)diagnosis and treatment of a patient with double primary hepatocellular carcinoma and ovarian cancer.The nature of the liver and pelvic masses in this patient was difficult to determine.In the first MDT discussion,the pelvic mass was considered to be ovarian cancer with local pelvic metastasis,but the nature of the liver lesion was uncertain.Was it a dual primary tumor or metastatic cancer?Liver biopsy indicated hepatocellular carcinoma.The second MDT dis-cussion concluded that the liver tumor was prone to rupture and bleeding,and the two lesions could be surgically removed simultaneously.Therefore,liver tumor,ovarian,uterine,and mesothelial resection were performed at the same time.Postoperative pathological examination confirmed hepatocellular carcinoma and high-grade serous carcinoma of the ovary.Chemotherapy with paclitaxel and carboplatin was ad-ministrated combined with bevacizumab.At the 38-month follow-up,the patient was recurrence-free.MDT was conducive to the diagnosis and treatment of this relatively rare double primary malignant tumors of the liver and ovary,and the patient achieved a better survival.