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

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2.	Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin, 2012, 62(6): 394-399.
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5.	中國抗癌協會肝癌專業委員會轉化治療協作組. 肝癌轉化治療中國專家共識(2021版). 中國實用外科雜志, 2021, 41(6): 618-632.
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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.	張曉赟, 朱心睿, 彭偉, 等. 經肝動脈化療栓塞+侖伐替尼+PD-1單抗在中晚期不可切除肝癌轉化切除中的安全性和有效性的前瞻性隊列研究: 初步報告. 中國普外基礎與臨床雜志, 2022, 29(1): 39-45.
20.	安文, 沈俊頤, 朱心睿, 等. 侖伐替尼聯合TACE和PD-1單抗治療復發肝癌的安全性與有效性探索. 中國普外基礎與臨床雜志, 2022, 29(10): 1289-1295.
21.	任龍, 張云, 張淼. 復發性肝癌治療方式的合理選擇. 肝膽外科雜志, 2022, 30(4): 317-320.
22.	樊嘉. 我國肝癌診療和臨床研究進展. 中國實用外科雜志, 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. 陳孝平, 張志偉. 肝癌多學科綜合治療團隊建立與運作. 中國實用外科雜志, 2014, 34(8): 685-687.
4. 趙明, 伍家鳴, 商昌珍, 等. 肝癌轉化治療相關技術方法及評價. 中國實用外科雜志, 2021, 41(3): 262-268.
5. 中國抗癌協會肝癌專業委員會轉化治療協作組. 肝癌轉化治療中國專家共識(2021版). 中國實用外科雜志, 2021, 41(6): 618-632.
6. 文天夫. 轉化切除是提高肝細胞癌切除率的重要途徑. 中國普外基礎與臨床雜志, 2020, 27(2): 133-136.
7. 中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療指南(2022年版). 中華消化外科雜志, 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. 張曉赟, 朱心睿, 彭偉, 等. 經肝動脈化療栓塞+侖伐替尼+PD-1單抗在中晚期不可切除肝癌轉化切除中的安全性和有效性的前瞻性隊列研究: 初步報告. 中國普外基礎與臨床雜志, 2022, 29(1): 39-45.
20. 安文, 沈俊頤, 朱心睿, 等. 侖伐替尼聯合TACE和PD-1單抗治療復發肝癌的安全性與有效性探索. 中國普外基礎與臨床雜志, 2022, 29(10): 1289-1295.
21. 任龍, 張云, 張淼. 復發性肝癌治療方式的合理選擇. 肝膽外科雜志, 2022, 30(4): 317-320.
22. 樊嘉. 我國肝癌診療和臨床研究進展. 中國實用外科雜志, 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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