Successful surgical resection of large hepatocellular carcinoma with portal vein tumor thrombus after conversion therapy with mFOLFOX-HAIC combined with donafenib and sintilimab:two case reports and a literature review

The aim of our study was to evaluate the clinical efficacy of m FOLFOX-HAIC combined with donafenib and sintilimab conversion therapy followed by surgical resection of large hepatocellular carcinoma with portal vein tumor thrombus(PVTT).The clinical data of two patients with large hepatocellular carcinoma who were admitted to the Second Affiliated Hospital of Kunming Medical University were retrospectively collected.Both patients received m FOLFOX-HAIC combined with donafenib and sintilimab conversion therapy,followed by hepatectomy.Clinical data were reported,and clinical efficacy was evaluated.One patient had a 14.5×11.1 cm tumor with a tumor thrombus in the right portal vein.The other patient had a 12.1×8.3 cm tumor with portal and hepatic vein tumor thrombi.Both patients had CNLC stageⅢa prior to conversion therapy,which was reduced to stageⅠb after conversion therapy.Subsequently,the patient underwent open and laparoscopic right hemihepatectomies.Short-term high-intensity conversion therapy with m FOLFOXHAIC combined with donafenib and sintilimab is a feasible and effective treatment for patients with large hepatocellular carcinoma with PVTT.

混合磨玻璃结节型肺腺癌脏层胸膜侵犯的临床特征和危险因素分析

背景与目的目前国内肺癌仍是发病率和致死率最高的恶性肿瘤,肺腺癌是其最常见的亚型,影像学中表现为混合性磨玻璃结节(mixed ground glass nodule,m GGN)的肺癌逐渐增多。脏层胸膜侵犯(visceral pleural invasion,VPI)是影响m GGN型肺腺癌预后的重要因素。本研究旨在探索分析m GGN型肺腺癌发生VPI的危险因素。方法回顾性分析2016年11月-2019年11月南京医科大学第一附属医院收治的接受根治性手术的128例m GGN型肺腺癌患者的临床资料,包括影像、病理和生物学特征,其中男性40例、女性88例,年龄30岁-81(60.3±9.3)岁。采用单因素卡方检验与多因素Logistic回归分析调查m GGN型肺腺癌发生VPI的各项危险因素。结果符合纳入标准的128例m GGN型肺腺癌患者中57例被诊断有VPI发生。性别、实性成分最大径、实性成分比例(consolidation tumor ratio,CTR)、毛刺征、肺部疾病史、高血压家族史、肿瘤-胸膜空间位置分型(relation of lesion to pleura,RLP)、支气管与结节走行关系在VPI(+)组和VPI(-)组间的差异均有统计学意义(P<0.05)。Logistic多因素回归分析发现RLP(OR=3.529,95%CI:1.430-8.713,P=0.006)和支气管与结节走行关系(OR=3.993,95%CI:1.517-10.51,P=0.005)是VPI发生的独立危险因素(P<0.05)。结论临床诊治应综合上述参数评估m GGN型肺腺癌发生VPI的可能性。RLP和支气管与结节走行关系异常作为VPI的独立危险因素,对判断m GGN型肺腺癌发生VPI具有一定的指导意义。