Conversion therapy of multiple intrahepatic metastases with portal vein tumor thrombus after radical resection of giant hepatocellular carcinoma：a case of MDT discussion_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUAN Chengxiang ^1,2 , YANG Chong ^1,3 , PANG Beichuan ^1,3 , LIAO Yubo ^1,2 , HUANG Liang ^1,2 , YANG Wenhao ^1,3 ,  ZHANG Yu ^1,3

1. Department of Hepatobiliary Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
2. School of Medicine, Chengdu Medical College, Chengdu 610500, P. R. China;
3. University of Electronic Science and Technology School of Medicine, Chengdu 610054, P. R. China;

Corresponding author：

ZHANG Yu, Email: 68532815@qq.com

Keywords：

hepatocellular carcinoma; recurrence; conversion therapy; multi-disciplinary team

DOI：

10.7507/1007-9424.202301024

Video：

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Objective To investigate the value of multi-disciplinary team (MDT) for the diagnosis and treatment of postoperative recurrence of hepatocellular carcinoma (HCC). Method The clinicopathologic data of a patient with giant HCC (66 mm×60 mm×102 mm) who was multiple intrahepatic metastases with portal vein tumor thrombus after radical resection, admitted to the Department of Hepatobiliary Surgery of Sichuan Provincial People’s Hospital, were gathered. Results The patient was a middle-aged male. The multiple recurrent intrahepatic metastases combined with portal vein right branch thrombosis was found at 1 month after radical hepatectomy. After MDT discussion and evaluation, the hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy (chemical drugs regimen was FOLFOX, immunotherapy drug was sindilizumab, targeted therapy drug was lenvatinib) was administered. After 3 times conversion therapy, and most of the intrahepatic lesions liquefied and necrotic and shrunk markedly or disappeared. After further discussion and evaluation by MDT, radical surgical resection was performed. The postoperative pathological examination results showed granulomatous inflammation with necrosis, and no exact liver cancer cells were detected. At 6 months after surgery, no tumor recurrence was observed.Conclusions For early recurrence combined with portal vein thrombosis after radical resection for HCC, hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy may still be effective and even has an opporunity of surgical therapy. MDT discussion can provide the best treatment plan for patient with recurrent liver cancer, leading to a better clinical outcome for them.

Citation： YUAN Chengxiang, YANG Chong, PANG Beichuan, LIAO Yubo, HUANG Liang, YANG Wenhao, ZHANG Yu. Conversion therapy of multiple intrahepatic metastases with portal vein tumor thrombus after radical resection of giant hepatocellular carcinoma：a case of MDT discussion. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(5): 543-548. doi: 10.7507/1007-9424.202301024 Copy

1.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2.	Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin, 2012, 62(6): 394-399.
3.	陈孝平, 张志伟. 肝癌多学科综合治疗团队建立与运作. 中国实用外科杂志, 2014, 34(8): 685-687.
4.	赵明, 伍家鸣, 商昌珍, 等. 肝癌转化治疗相关技术方法及评价. 中国实用外科杂志, 2021, 41(3): 262-268.
5.	中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识(2021版). 中国实用外科杂志, 2021, 41(6): 618-632.
6.	文天夫. 转化切除是提高肝细胞癌切除率的重要途径. 中国普外基础与临床杂志, 2020, 27(2): 133-136.
7.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版). 中华消化外科杂志, 2022, 21(2): 143-168.
8.	Calderaro J, Petitprez F, Becht E, et al. Intra-tumoral tertiary lymphoid structures are associated with a low risk of early recurrence of hepatocellular carcinoma. J Hepatol, 2019, 70(1): 58-65.
9.	Xu XF, Xing H, Han J, et al. Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma: a multicenter study from China. JAMA Surg, 2019, 154(3): 209-217.
10.	European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 2018, 69(1): 182-236.
11.	Benson AB, D’Angelica MI, Abbott DE, et al. NCCN guidelines insights: hepatobiliary cancers, version 1. 2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
12.	Hatooka M, Kawaoka T, Aikata H, et al. Hepatic arterial infusion chemotherapy followed by sorafenib in patients with advanced hepatocellular carcinoma (HICS 55): an open label, non-comparative, phase Ⅱ trial. BMC Cancer, 2018, 18(1): 633. doi: 10.1186/s12885-018-4519-y.
13.	Omata M, Cheng AL, Kokudo N, et al. Asia-pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int, 2017, 11(4): 317-370.
14.	Kudo M, Matsui O, Izumi N, et al. JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the Liver Cancer Study Group of Japan. Liver Cancer, 2014, 3(3-4): 458-468.
15.	Lyu N, Lin Y, Kong Y, et al. FOXAI: a phase Ⅱ trial evaluating the efficacy and safety of hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin for advanced hepatocellular carcinoma. Gut, 2018, 67(2): 395-396.
16.	He MK, Liang RB, Zhao Y, et al. Lenvatinib, toripalimab, plus hepatic arterial infusion chemotherapy versus lenvatinib alone for advanced hepatocellular carcinoma. Ther Adv Med Oncol, 2021, 13: 17588359211002720. doi: 10.1177/17588359211002720.
17.	Mei J, Tang YH, Wei W, et al. Hepatic arterial infusion chemotherapy combined with PD-1 inhibitors plus lenvatinib versus PD-1 inhibitors plus lenvatinib for advanced hepatocellular carcinoma. Front Oncol, 2021, 11: 618206. doi: 10.3389/fonc.2021.618206.
18.	Shi M, Li Q, He M, et al. Hepatic arterial infusion chemotherapy with oxaliplation, fluorouracil, and leucovorin versus transrterial chemoembolization for unresectable hepatocellular carcinoma: a randomized phase Ⅲ trial. Ann Oncol, 2020, 31(suppl4): 629-644.
19.	张晓赟, 朱心睿, 彭伟, 等. 经肝动脉化疗栓塞+仑伐替尼+PD-1单抗在中晚期不可切除肝癌转化切除中的安全性和有效性的前瞻性队列研究: 初步报告. 中国普外基础与临床杂志, 2022, 29(1): 39-45.
20.	安文, 沈俊颐, 朱心睿, 等. 仑伐替尼联合TACE和PD-1单抗治疗复发肝癌的安全性与有效性探索. 中国普外基础与临床杂志, 2022, 29(10): 1289-1295.
21.	任龙, 张云, 张淼. 复发性肝癌治疗方式的合理选择. 肝胆外科杂志, 2022, 30(4): 317-320.
22.	樊嘉. 我国肝癌诊疗和临床研究进展. 中国实用外科杂志, 2019, 39(10): 1010-1014.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin, 2012, 62(6): 394-399.
3. 陈孝平, 张志伟. 肝癌多学科综合治疗团队建立与运作. 中国实用外科杂志, 2014, 34(8): 685-687.
4. 赵明, 伍家鸣, 商昌珍, 等. 肝癌转化治疗相关技术方法及评价. 中国实用外科杂志, 2021, 41(3): 262-268.
5. 中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识(2021版). 中国实用外科杂志, 2021, 41(6): 618-632.
6. 文天夫. 转化切除是提高肝细胞癌切除率的重要途径. 中国普外基础与临床杂志, 2020, 27(2): 133-136.
7. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版). 中华消化外科杂志, 2022, 21(2): 143-168.
8. Calderaro J, Petitprez F, Becht E, et al. Intra-tumoral tertiary lymphoid structures are associated with a low risk of early recurrence of hepatocellular carcinoma. J Hepatol, 2019, 70(1): 58-65.
9. Xu XF, Xing H, Han J, et al. Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma: a multicenter study from China. JAMA Surg, 2019, 154(3): 209-217.
10. European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 2018, 69(1): 182-236.
11. Benson AB, D’Angelica MI, Abbott DE, et al. NCCN guidelines insights: hepatobiliary cancers, version 1. 2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
12. Hatooka M, Kawaoka T, Aikata H, et al. Hepatic arterial infusion chemotherapy followed by sorafenib in patients with advanced hepatocellular carcinoma (HICS 55): an open label, non-comparative, phase Ⅱ trial. BMC Cancer, 2018, 18(1): 633. doi: 10.1186/s12885-018-4519-y.
13. Omata M, Cheng AL, Kokudo N, et al. Asia-pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int, 2017, 11(4): 317-370.
14. Kudo M, Matsui O, Izumi N, et al. JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the Liver Cancer Study Group of Japan. Liver Cancer, 2014, 3(3-4): 458-468.
15. Lyu N, Lin Y, Kong Y, et al. FOXAI: a phase Ⅱ trial evaluating the efficacy and safety of hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin for advanced hepatocellular carcinoma. Gut, 2018, 67(2): 395-396.
16. He MK, Liang RB, Zhao Y, et al. Lenvatinib, toripalimab, plus hepatic arterial infusion chemotherapy versus lenvatinib alone for advanced hepatocellular carcinoma. Ther Adv Med Oncol, 2021, 13: 17588359211002720. doi: 10.1177/17588359211002720.
17. Mei J, Tang YH, Wei W, et al. Hepatic arterial infusion chemotherapy combined with PD-1 inhibitors plus lenvatinib versus PD-1 inhibitors plus lenvatinib for advanced hepatocellular carcinoma. Front Oncol, 2021, 11: 618206. doi: 10.3389/fonc.2021.618206.
18. Shi M, Li Q, He M, et al. Hepatic arterial infusion chemotherapy with oxaliplation, fluorouracil, and leucovorin versus transrterial chemoembolization for unresectable hepatocellular carcinoma: a randomized phase Ⅲ trial. Ann Oncol, 2020, 31(suppl4): 629-644.
19. 张晓赟, 朱心睿, 彭伟, 等. 经肝动脉化疗栓塞+仑伐替尼+PD-1单抗在中晚期不可切除肝癌转化切除中的安全性和有效性的前瞻性队列研究: 初步报告. 中国普外基础与临床杂志, 2022, 29(1): 39-45.
20. 安文, 沈俊颐, 朱心睿, 等. 仑伐替尼联合TACE和PD-1单抗治疗复发肝癌的安全性与有效性探索. 中国普外基础与临床杂志, 2022, 29(10): 1289-1295.
21. 任龙, 张云, 张淼. 复发性肝癌治疗方式的合理选择. 肝胆外科杂志, 2022, 30(4): 317-320.
22. 樊嘉. 我国肝癌诊疗和临床研究进展. 中国实用外科杂志, 2019, 39(10): 1010-1014.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Conversion therapy of multiple intrahepatic metastases with portal vein tumor thrombus after radical resection of giant hepatocellular carcinoma：a case of MDT discussion

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