探讨免疫治疗联合靶向药物治疗对复发性肉瘤样肝细胞癌（SHC）的疗效。

患者男，47岁，因"肝癌切除术后8个月，肿瘤复发1周"入院。8个月前行肝右叶肝癌切除术，术后病理示肝右叶SHC。既往无肝炎、糖尿病等病史。HBsAg（-），AFP、CA19-9、CEA均正常。肝功能Child-Pugh分级A级，ICGR15为0.035。上腹部CT示：肝Ⅴ、Ⅵ、Ⅷ段肝癌，肝门部淋巴结转移。患者签署知情同意书，符合医学伦理学规定。经积极术前准备后行右半肝切除+肝门淋巴结清扫。

术后8个月肝脏SHC再次复发，位于肝Ⅰ、Ⅳ段及Ⅰ段和Ⅳ段交界处，无根治性切除机会。免疫组化检测显示肿瘤程序性死亡受体-配体1（PD-L1）阳性率为1%，遂给予免疫治疗+靶向药物治疗。免疫治疗方案为：卡瑞利珠单抗200 mg，每21天一次。靶向药物治疗方案为：甲磺酸阿帕替尼0.25 g，每天一次。治疗3个月复查CT示肿瘤较前缩小，肿瘤学评价（mRECIST）达到完全缓解。临床观察无不良反应发生。随防22个月，达到完全缓解。

免疫治疗联合靶向药物治疗为术后复发性PD-L1阳性SHC患者提供有效的治疗策略。

To evaluate the clinical efficacy of immunotherapy combined with targeted drug in the treatment of recurrent sarcomatoid hepatocellular carcinoma (SHC).

A 47-year-old male patient was admitted to hospital due to "tumor recurrence for 1 week at 8 months after hepatectomy". He underwent hepatectomy for liver cancer in the right lobe 8 months ago. Postoperative pathological examination indicated SHC in the right lobe. The patient had no history of hepatitis or diabetes mellitus. HBsAg was negative and the levels of AFP, CA19-9 and CEA were all normal. Liver function was graded as Child-Pugh A. ICGR15 was 0.035. Upper abdominal CT scan revealed liver cancer in segment Ⅴ, Ⅵ and Ⅷ with lymph node metastasis at the porta. The informed consent of this patient was obtained and the local ethical committee approval was received. After active preoperative preparations, right hemihepatectomy combined with hilar lymph node dissection were performed on the patient.

SHC recurred again at the segments of Ⅰ, Ⅳ and Ⅰ/Ⅳ 8 months after operation, and there was no chance of radical resection. Immunohistochemical staining demonstrated that the positive rate of programmed death-ligand 1 (PD-L1) in the tumor tissues was 1%. Consequently, immunotherapy and targeted drug therapy were delivered. Immunotherapy regime was 200 mg of Karelizumab, once every 21 d. The targeted drug treatment regimen was 0.25 g of apatinib mesylate, once daily. After 3-month treatment, CT scan revealed that the tumor size was reduced. According to the mRECIST criteria, the patient achieved complete remission. No adverse reaction was observed. Complete remission was achieved after 22 months of follow-up.

Immunotherapy combined with targeted drug provide an effective therapeutic strategy for recurrence of PD-L1-positive SHC after surgical resection.