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.