原发性肝癌Ⅲa期降期后肝切除临床疗效分析

Clinical efficacy of hepatectomy after down-staging treatments in patients with stageⅢa primary liver cancer

目的探讨原发性肝癌(肝癌)Ⅲa期降期后肝切除的疗效。方法回顾性分析2020年12月至2021年7月解放军总医院第五医学中心收治的4例晚期肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男3例,女1例;年龄40~65岁,中位年龄59岁。肝癌均为Ⅲa期,4例美国东部肿瘤协作组-体力状态(ECOG-PS)评分均为0分,Child-Pugh分级均为A级;乙型和丙型病毒性肝炎各2例。肿瘤位于肝右叶3例,肝左叶1例;伴有门静脉癌栓4例。观察患者诊治过程、复发生存情况。结果患者均接受TACE联合靶向免疫综合治疗,系统治疗前全部给予抗病毒、保肝等治疗。影像学检查肿瘤体积缩小,肿瘤大部分坏死。再次评估肝功能Child-Pugh分级A级,ICGR15<0.10。积极准备后行根治性肝癌切除,术后均顺利出院,无严重并发症发生。降期后,术后病理评估为显著病理缓解(MPR)3例,完全病理缓解(CPR)1例。术后继续靶向免疫综合治疗。1例术后3个月肿瘤复发,经TACE+消融治疗后稳定;1例术后1个月肿瘤爆发式肝内转移,对复发的肿瘤均采取积极的综合治疗。随访至2022年4月,其余2例未见新发肿瘤。结论对于晚期不可切除肝癌,经TACE联合靶向免疫综合治疗,降期转化后根治性手术可延长患者的生存期。

Objective To evaluate clinical efficacy of hepatectomy after down-staging treatments in patients with stageⅢa primary liver cancer(PLC).Methods Clinical data of 4 patients with advanced PLC admitted to the Fifth Medical Center of PLA General Hospital from December 2020 to July 2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,3 patients were male and 1 female,aged from 40 to 65 years,with a median age of 59 years.All patients were diagnosed with stageⅢa PLC.Eastern Cooperative Oncology Group-Performance Status(ECOG-PS)scores and Child-Pugh stages of 4 patients were all 0 and stage A.2 patients were diagnosed with viral hepatitis B and 2 cases of viral hepatitis C.The tumors were located in the right lobe in 3 cases and in the left lobe in 1 case.4 patients were complicated with portal vein tumor thrombus.The diagnosis,treatment,recurrence and survival of all patients were observed.Results All patients underwent TACE combined with targeted immunotherapy.All patients received antiviral and liver protection interventions prior to systemic treatments.Imaging examination showed that the tumor volume was decreased and necrosis was noted in most tumors.Liver function was reevaluated as Child-Pugh A and ICGR15<0.10.Radical resection was performed after active preparation,and all patients were discharged without severe complications.After down-staging,3 patients achieved major pathological response(MPR)and 1 case of complete pathological response(CPR).Targeted immunotherapy was continuously given after surgery.One patient recurred at postoperative 3 months and was stable after TACE+ablation.One patient developed explosive intrahepatic metastasis at 1 month after surgery,and all recurrent tumors were treated with active comprehensive treatments.During follow-up until April 2022,no new tumors had been found in the remaining 2 cases.Conclusions For unresectable advanced PLC,TACE combined with targeted immunotherapy can prolong the survival of patients undergoing radical surgery after down-staging.