目的

探讨中晚期肝癌TACE 联合靶向免疫转化治疗疗效和经验。

方法

患者男，50 岁，因“体检发现肝脏占位”于2021 年6 月12 日入院。入院诊断：原发性肝癌（CNLCⅢa 期），慢性乙型病毒性肝炎，胆囊结石。肝功能Child-Pugh 分级A 级，东部肿瘤协作组-体能状态（ECOG-PS）评分0 分。初步评估无手术根治切除机会，随即组织多学科诊疗模式（MDT）会诊后采用TACE 联合靶向免疫治疗，方案：仑伐替尼8 mg 每天一次，卡瑞丽珠单抗 200 mg 每两周一次。 经半年靶向免疫治疗和两次TACE 治疗，肿瘤得到明显控制。

结果

经积极术前准备，于2022 年1 月27 日行ALPPS-Ⅰ期手术，术式采用腹腔镜下门静脉右支结扎+肝组织离断术+胆囊切除术。于2022 年4 月22 日行腹腔镜下肝右三叶切除术，术后恢复顺利，无并发症发生。术后病理学检查示肝脏病灶区全为凝固性坏死物，坏死组织边缘局灶可见多核巨细胞反应及肉芽组织增生，距病灶≥1 cm 及＜1 cm 肝组织未见癌，脉管内未见癌栓。随访至2023 年8 月，未见复发转移病灶，门静脉癌栓消失。截至投稿日患者继续使用仑伐替尼+卡瑞丽珠单抗治疗。

结论

TACE 联合靶向免疫转化治疗后实施ALPPS 可使部分中晚期肝癌患者获益。

Objective

To evaluate the efficacy and share the experience of TACE combined with targeted immunotherapy for middle stage and advanced liver cancer.

Methods

A 50-year-old male patient was admitted to our hospital due to ＂a liver mass detected in physical examination＂ on June 12, 2021.Diagnosis upon admission: primary liver cancer (CNLC stage Ⅲa), chronic hepatitis B and cholecystolithiasis.Child-Pugh A, and Eastern Cooperative Oncology Group-Performance Status (ECOG-PS)score was 0.Preliminary evaluation indicated that radical resection could not be performed, and subsequent multidisciplinary team (MDT) diagnosis and treatment consultation recommended TACE combined with targeted immunotherapy.The protocol was given as follows: 8 mg of lenvatinib once a day and 200 mg of camrelizumab once every two weeks.After 6-month targeted immunotherapy and twice TACE, the tumor was significantly controlled.

Results

After active preoperative preparations, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)-Ⅰ stage surgery was performed on January 27, 2022.Laparoscopic ligation of the right portal vein combined with hepatic tissue dissection and cholecystectomy was adopted.Laparoscopic right trisectionectomy was performed on April 22, 2022.The patient achieved successful postoperative recovery without postoperative complications.Postoperative pathological examination showed that the liver lesion was coagulation necrosis, and multinucleated giant cell reaction and granulation tissue hyperplasia could be seen on the margins of necrotic tissues.No cancer was found in the liver tissue ≥ 1 cm and ＜ 1 cm from the lesion, and no tumor thrombus was found in the vessels.In the postoperative follow-up until August, 2023, no recurrence or metastasis was found.Portal vein tumor thrombus was absent.Until the paper submission date, the patient was continually treated with lenvatinib combined with camrelizumab.

Conclusions

ALPPS after TACE combined with targeted immunotherapy can bring benefits to partial patients with middle stage or advanced liver cancer.