Experience in comprehensive treatment of a case of difficult and complex hepatocellular carcinoma under the MDT mode_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Yunhao ¹ , LI Haoquan ¹ ,  WANG Zaiguo ¹ , ZHANG Weibiao ² , ZHANG Xuefang ³ , ZHANG Zhicheng ⁴ , LIAO Jingsheng ⁵ , MO Yanxia ¹ , YE Zhenwei ¹ , JIANG Jingzhu ¹

1. Department of Hepatobiliary and Pancreatic Surgery, Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province), Dongguan, Guangdong 523059, P. R. China;
2. Department of Nuclear Medicine, Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province), Dongguan, Guangdong 523059, P. R. China;
3. Department of Radiotherapy, Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province), Dongguan, Guangdong 523059, P. R. China;
4. Department of Interventional Medicine, Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province), Dongguan, Guangdong 523059, P. R. China;
5. Department of Oncology, Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province), Dongguan, Guangdong 523059, P. R. China;

Corresponding?author：

WANG Zaiguo, Email: wangzaiguo@sina.com

Keywords：

hepatocellular carcinoma; multidisciplinary team; prostate metastatic cancer; treatment; effectiveness

DOI：

10.7507/1007-9424.202403088

Video：

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Objective To summarize the comprehensive multidisciplinary team (MDT) treatment and holistic scientific management approach in a case of hepatocellular carcinoma (HCC) in S7+S9 segments with prostatic metastasis. Methods A retrospective analysis was conducted on the clinical data and follow-up outcomes of a patient with HCC in S7+S9 segments who developed prostatic metastasis during treatment, admitted to the Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province). Results Due to the complexity of the patient’s condition, an MDT discussion was held upon initial admission. It was concluded that the HCC diagnosis was clear, with lesions confined to the liver (S7+S9 segments) and a tumor diameter less than 3 cm, making surgical resection or ablation therapy the preferred options. However, the patient declined liver transplantation and surgical resection. Therefore, CT-guided microwave ablation (MWA) was performed on the primary HCC lesions in segments S7 and S9b. Prior to subsequent treatments for recurrent disease, MDT discussions were held again, and treatments were tailored to the discussion outcomes while respecting the patient’s wishes. Over time, the patient underwent CT-guided liver puncture MWA, re-ablation for recurrent tumors, transarterial chemoembolization (TACE), stereotactic body radiation therapy (SBRT), targeted therapy, and immunotherapy. Following this comprehensive MDT treatment plan, the patient had survived for over 78 months, with no evidence of active tumor lesions in the liver, prostate, or other parts of the body. Alpha-fetoprotein levels and liver function remained normal, and the patient’s quality of life was good. Conclusion Comprehensive MDT treatment incorporates various technologies and approaches, along with holistic scientific management, can yield favorable outcomes for patients with complex and challenging HCC.

Citation： CHEN Yunhao, LI Haoquan, WANG Zaiguo, ZHANG Weibiao, ZHANG Xuefang, ZHANG Zhicheng, LIAO Jingsheng, MO Yanxia, YE Zhenwei, JIANG Jingzhu. Experience in comprehensive treatment of a case of difficult and complex hepatocellular carcinoma under the MDT mode. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(9): 1063-1069. doi: 10.7507/1007-9424.202403088 Copy

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10.	陳延宇, 張曉赟, 李川, 等. 復發性肝細胞癌的外科治療現狀與進展. 華西醫學, 2019, 34(6): 688-692.
11.	丁福全, 王在國. 肝癌復發轉移的臨床研究進展. 中國實用外科雜志, 2000, 20(3): 46-47.
12.	Sugawara Y, Hibi T. Surgical treatment of hepatocellular carcinoma. Biosci Trends, 2021, 15(3): 138-141.
13.	張煌斌, 鄢業鴻, 萬昊, 等. 原發性肝癌前列腺轉移1例報告. 臨床肝膽病雜志, 2021, 37(6): 1427-1428.
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1. 中國抗癌協會肝癌專業委員會. 中國肝癌多學科綜合治療專家共識. 中國醫學前沿雜志(電子版), 2020, 12(12): 28-36.
2. Naugler WE, Alsina AE, Frenette CT, et al. Building the multidisciplinary team for management of patients with hepatocellular carcinoma. Clin Gastroenterol Hepatol, 2015, 13(5): 827-835.
3. 中華人民共和國國家衛生和計劃生育委員會. 原發性肝癌診療規范 (2017年版). 臨床肝膽病雜志, 2017, 33(8): 1419-1431.
4. 四川大學華西醫院肝癌MDT團隊. 肝細胞肝癌全程多學科規范化管理: 華西醫院多學科專家共識(第二版). 中國普外基礎與臨床雜志, 2020, 27(9): 1062-1077.
5. 中華醫學會超聲醫學分會, 中國研究型醫院學會腫瘤介入專業委員會. 影像引導原發性肝癌消融指南(2023版). 中華肝臟病雜志, 2024, 32(2): 97-112.
6. 劉允怡, 遲天毅. 肝臟S9段. 中華外科雜志, 2002, 40(5): 25-26.
7. 劉允怡. 肝切除與肝移植應用解剖學. 北京: 人民衛生出版社, 2016: 20-25.
8. 張偉標, 黃彥, 王在國, 等. 肝臟S9段的應用解剖及精準微創消融. 中國普外基礎與臨床雜志, 2023, 30(8): 905-910.
9. 王在國, 張偉標, 葉振偉, 等. CT引導下經皮肝穿刺微波消融治療Ⅸ段原發性肝癌的臨床研究. 中華肝膽外科雜志, 2020, 26(11): 825-828.
10. 陳延宇, 張曉赟, 李川, 等. 復發性肝細胞癌的外科治療現狀與進展. 華西醫學, 2019, 34(6): 688-692.
11. 丁福全, 王在國. 肝癌復發轉移的臨床研究進展. 中國實用外科雜志, 2000, 20(3): 46-47.
12. Sugawara Y, Hibi T. Surgical treatment of hepatocellular carcinoma. Biosci Trends, 2021, 15(3): 138-141.
13. 張煌斌, 鄢業鴻, 萬昊, 等. 原發性肝癌前列腺轉移1例報告. 臨床肝膽病雜志, 2021, 37(6): 1427-1428.
14. 曾效力, 樊長姝. 前列腺轉移癌一例. 實用醫學影像雜志, 2003, 4(6): 358.
15. Liu K, Hao M, Ouyang Y, et al. CD133⁺ cancer stem cells promoted by VEGF accelerate the recurrence of hepatocellular carcinoma. Sci Rep, 2017, 7: 41499. doi: 10.1038/srep41499.
16. Park DJ, Sung PS, Lee GW, et al. Preferential expression of programmed death ligand 1 protein in tumor-associated macrophages and its potential role in immunotherapy for hepatocellular carcinoma. Int J Mol Sci, 2021, 22(9): 4710. doi: 10.3390/ijms22094710.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience in comprehensive treatment of a case of difficult and complex hepatocellular carcinoma under the MDT mode

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