阿特珠单抗联合贝伐珠单抗治疗伴肾上腺转移和血管侵犯的

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阿特珠单抗联合贝伐珠单抗治疗伴肾上腺转移和血管侵犯的巨大肝细胞癌中转肝切除一例

    星野隆史、长沼敦史、古泽爱、铃木友平、平井圭太郎、坂本一郎、小川哲史、小川明、畑中武史、柿崎悟

胃肠病学临床杂志第 15 卷，第 776–783 页（2022 年）引用这篇文章

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我们在此报告了一例伴有肾上腺转移和血管侵犯的巨大肝细胞癌 (HCC) 在阿特珠单抗-贝伐单抗治疗后通过转化肝切除术成功治疗的病例。一名 77 岁男性患者因胸痛入院。有HCC治疗史；然而，患者根据自己的决定停止接受后续治疗。这一次，他时隔5年第一次到我院急诊科就诊。右叶肿瘤长成肿块，有肾上腺转移瘤，直径15厘米。它侵入了下腔静脉。选择 Atezolizumab-bevacizumab 治疗用于 HCC 治疗。在开始治疗之前，他的肝功能得以保留（Child-Pugh A5）。他的甲胎蛋白 (AFP) 和脱-γ-羧基凝血酶原 (DCP) 水平分别为 759.0 ng/mL 和 5,681 mAU/mL。 Atezolizumab-贝伐单抗治疗导致肿瘤标志物水平和肿瘤染色显着降低。在 9 个疗程的 atezolizumab-bevacizumab 治疗后，由于蛋白尿，难以继续使用贝伐单抗。由于肿瘤体积缩小且肿瘤标志物在正常范围内，我们决定进行中转肝切除术。肿瘤通过膈肌联合切除完全切除，病理分析显示对atezolizumab-bevacizumab治疗完全反应。组织学分析中没有存活的肿瘤细胞。患者在转换手术后 3 个月表现良好，没有任何复发迹象。

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A case of conversion hepatectomy for huge hepatocellular carcinoma with adrenal metastasis and vascular invasion after atezolizumab–bevacizumab treatment

    Takashi Hoshino, Atsushi Naganuma, Ai Furusawa, Yuhei Suzuki, Keitaro Hirai, Ichiro Sakamoto, Tetsushi Ogawa, Akira Ogawa, Takeshi Hatanaka & Satoru Kakizaki

Clinical Journal of Gastroenterology volume 15, pages 776–783 (2022)Cite this article

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Abstract

We herein report a case of huge hepatocellular carcinoma (HCC) with adrenal metastasis and vascular invasion successfully treated by conversion hepatectomy after atezolizumab–bevacizumab treatment. A 77-year-old male patient with chest pain was admitted. He had a history of HCC treatment; however, the patient stopped receiving follow-up treatment based on his own decision. This time, he visited the emergency department of our hospital for the first time in 5 years. The tumor at the right lobe had grown into a lump with adrenal metastases and was 15 cm in diameter. It had invaded the inferior vena cava. Atezolizumab–bevacizumab treatment was selected for HCC treatment. Before starting treatment, his liver function was preserved (Child–Pugh A5). His alpha fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) levels were 759.0 ng/mL and 5,681 mAU/mL, respectively. Atezolizumab–bevacizumab treatment resulted in a marked decrease in tumor marker levels and tumor staining. After nine courses of atezolizumab–bevacizumab treatment, it became difficult to continue the administration of bevacizumab because of proteinuria. Because the tumor had decreased in size and the tumor markers were in the normal range, we decided to perform conversion hepatectomy. The tumor was completely removed by combined resection of the diaphragm, and pathological analyses showed a complete response to atezolizumab–bevacizumab treatment. No viable tumor cells remained on histological analyses. The patient is doing well without any signs of recurrence at 3 months after conversion surgery.