肝细胞癌伴Ⅳ型门静脉癌栓患者经局部及靶向治疗完全缓解1例
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摘要
肝细胞癌(hepatocellular carcinoma,HCC)合并门静脉癌栓(portal vein tumor thrombus,PVTT),尤其是Ⅳ型癌栓者难治疗、预后差。本文报道1例初诊确诊为HCC合并Ⅲ型PVTT患者,经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)1次+射频消融治疗(radiofrequency ablation,RFA)1次+索拉非尼(400 mg,每日2次)治疗1个月后进展为HCC合并Ⅳ型癌栓,经乐伐替尼(12 mg,每日1次)治疗1个月达肿瘤降期,再次联合TACE治疗1次+RFA治疗1次,肿瘤评估完全缓解(complete remission,CR)。
Patients of hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT), especially those with type Ⅳ PVTT were difficult to treat and the prognosis was poor. This paper reported a newly diagnosed case of HCC with type Ⅲ PVTT, who was treated by transcatheter arterial chemoembolization(TACE) one time + radiofrequency ablation(RFA) one time + sorafenib(400 mg, twice per day) for one month, then the case progressed to type Ⅳ PVTT and received lenvatinib(12 mg, once per day) for one month, and the stage of tumor descended. The patient received TACE(one time) + RFA(one time) again, and the tumor assessment reached complete remission(CR).
Patients of hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT), especially those with type Ⅳ PVTT were difficult to treat and the prognosis was poor. This paper reported a newly diagnosed case of HCC with type Ⅲ PVTT, who was treated by transcatheter arterial chemoembolization(TACE) one time + radiofrequency ablation(RFA) one time + sorafenib(400 mg, twice per day) for one month, then the case progressed to type Ⅳ PVTT and received lenvatinib(12 mg, once per day) for one month, and the stage of tumor descended. The patient received TACE(one time) + RFA(one time) again, and the tumor assessment reached complete remission(CR).
引文
[1]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Ferlay J,Soerjomataram I,Dikshit R,et al.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012[J].Int J Cancer,2015,136(5):E359-E386.
[4]荚卫东,刘文斌.《肝细胞癌合并门静脉癌栓多学科诊治中国专家共识(2016年版)》解读[J].中国普通外科杂志,2017,26(7):815-820.
[5]Yu JI,Park HC,Jung SH,et al.Combination treatment with transarterial chemoembolization,radiotherapy,and hyperthermia(CERT)for hepatocellular carcinoma with portal vein tumor thrombosis:Final results of a prospective phaseⅡtrial[J].Oncotarget,2017,8(32):52651-52664.
[6]Cheng AL,Kang YK,Chen Z,et al.Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma:a phaseⅢrandomised,double-blind,placebo-controlled trial[J].Lancet Oncol,2009,10(1):25-34.
[7]赵益,刘涛,沈象吉,等.索拉非尼治疗中晚期肝细胞肝癌的临床分析[J].中国现代普通外科进展,2015,18(8):601-604.
[8]王卫东,范晨,陆进,等.门静脉癌栓的射频治疗[J].中国医学计算机成像杂志,2016,22(5):454-456.
[9]罗君,郑家平,邵国良,等.肝动脉化学治疗栓塞联合125I粒子植入和索拉非尼治疗肝细胞癌门静脉癌栓的疗效比较[J].中华肝脏病杂志,2018,26(4):298-304
[10]韦腾,叶甲舟,庞业滨,等.肝细胞癌合并不同类型脉管癌栓的手术疗效分析[J].中华消化外科杂志,2018,17(3):285-291.
[11]方主亭,颜志平,罗剑钧,等.腔内植入I125粒子条联合经肝动脉化疗栓塞术治疗肝癌合并广泛性门静脉癌栓的疗效观察[J].中华肝脏病杂志,2013,21(2):146-149.
[12]中华人民共和国卫生和计划生育委员会医政管理局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):635-647.
[13]Catalano OA,Choy G,Zhu A,et al.Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma:application of diffusion-weighted MRimaging[J].Radiology,2010,254(1):154-162.
[14]Cheng S,Chen M,Cai J.Chinese expert consensuson multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus:2016 edition[J].Oncotarget,2017,8(5):8867-8876.
[15]程树群,陈汉,杨家和,等.肝癌门静脉癌栓分型的影像学意义[J].中华普通外科杂志,2004,19(4):200-201.
[16]Zhang ZM,Lai EC,Zhang C,et al.The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus[J].Int JSurg,2015,20:8-16.
[17]Pawarode A,Voravud N,Sriuranpong V,et al.Natural history of untreated primary hepatocellular carcinoma:a retrospective study of157 patients[J].Am J Clin Oncol,1998,21(4):386-391.
[18]Yang T,Lin C,Zhai J,et al.Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer(BCLC)staging[J].J Cancer Res Clin Oncol,2012,138(7):1121-1129.
[19]Luo J,Guo RP,Lai EC,et al.Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis:a prospective comparative study[J].Ann Surg Oncol,2011,18(2):413-420.
[20]全国肝癌合并癌栓诊治研究协作组,中国肿瘤科相关专家小组.肝细胞癌合并门静脉癌栓多学科诊治中国专家共识2016年版[J].中华消化外科杂志,2016,15(5):411-416.
[21]Bruix J,Raoul JL,Sherman M,et al.Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma:subanalyses of a phase III trial[J].J Hepatol,2012,57(4):821-829.
[22]Yamamoto Y,Matsui J,Matsushima T,et al.Lenvatinib,an angiogenesis inhibitor targeting VEGFR/FGFR,shows broad antitumor activity in human tumor xenograft models associated with microvessel density and pericyte coverage[J].Vasc Cell,2014,6:18.
[23]Matsui J,Yamamoto Y,Funahashi Y,et al.E7080,a novel inhibitor that targets multiple kinases,has potent antitumor activities against stem cell factor producing human small cell lung cancer H146,based on angiogenesis inhibition[J].Int J Cancer,2008,122(3):664-671.
[24]Yamada K,Yamamoto N,Yamada Y,et al.Phase I dose-escalation study and biomarker analysis of E7080 in patients with advanced solid tumors[J].Clin Cancer Res,2011,17(8):2528-2537.
[25]Kudo M,Finn RS,Qin S,et al.Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma:a randomised phase 3 non-inferiority trial[J].Lancet,2018,391(10126):1163-1173.
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Ferlay J,Soerjomataram I,Dikshit R,et al.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012[J].Int J Cancer,2015,136(5):E359-E386.
[4]荚卫东,刘文斌.《肝细胞癌合并门静脉癌栓多学科诊治中国专家共识(2016年版)》解读[J].中国普通外科杂志,2017,26(7):815-820.
[5]Yu JI,Park HC,Jung SH,et al.Combination treatment with transarterial chemoembolization,radiotherapy,and hyperthermia(CERT)for hepatocellular carcinoma with portal vein tumor thrombosis:Final results of a prospective phaseⅡtrial[J].Oncotarget,2017,8(32):52651-52664.
[6]Cheng AL,Kang YK,Chen Z,et al.Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma:a phaseⅢrandomised,double-blind,placebo-controlled trial[J].Lancet Oncol,2009,10(1):25-34.
[7]赵益,刘涛,沈象吉,等.索拉非尼治疗中晚期肝细胞肝癌的临床分析[J].中国现代普通外科进展,2015,18(8):601-604.
[8]王卫东,范晨,陆进,等.门静脉癌栓的射频治疗[J].中国医学计算机成像杂志,2016,22(5):454-456.
[9]罗君,郑家平,邵国良,等.肝动脉化学治疗栓塞联合125I粒子植入和索拉非尼治疗肝细胞癌门静脉癌栓的疗效比较[J].中华肝脏病杂志,2018,26(4):298-304
[10]韦腾,叶甲舟,庞业滨,等.肝细胞癌合并不同类型脉管癌栓的手术疗效分析[J].中华消化外科杂志,2018,17(3):285-291.
[11]方主亭,颜志平,罗剑钧,等.腔内植入I125粒子条联合经肝动脉化疗栓塞术治疗肝癌合并广泛性门静脉癌栓的疗效观察[J].中华肝脏病杂志,2013,21(2):146-149.
[12]中华人民共和国卫生和计划生育委员会医政管理局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):635-647.
[13]Catalano OA,Choy G,Zhu A,et al.Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma:application of diffusion-weighted MRimaging[J].Radiology,2010,254(1):154-162.
[14]Cheng S,Chen M,Cai J.Chinese expert consensuson multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus:2016 edition[J].Oncotarget,2017,8(5):8867-8876.
[15]程树群,陈汉,杨家和,等.肝癌门静脉癌栓分型的影像学意义[J].中华普通外科杂志,2004,19(4):200-201.
[16]Zhang ZM,Lai EC,Zhang C,et al.The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus[J].Int JSurg,2015,20:8-16.
[17]Pawarode A,Voravud N,Sriuranpong V,et al.Natural history of untreated primary hepatocellular carcinoma:a retrospective study of157 patients[J].Am J Clin Oncol,1998,21(4):386-391.
[18]Yang T,Lin C,Zhai J,et al.Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer(BCLC)staging[J].J Cancer Res Clin Oncol,2012,138(7):1121-1129.
[19]Luo J,Guo RP,Lai EC,et al.Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis:a prospective comparative study[J].Ann Surg Oncol,2011,18(2):413-420.
[20]全国肝癌合并癌栓诊治研究协作组,中国肿瘤科相关专家小组.肝细胞癌合并门静脉癌栓多学科诊治中国专家共识2016年版[J].中华消化外科杂志,2016,15(5):411-416.
[21]Bruix J,Raoul JL,Sherman M,et al.Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma:subanalyses of a phase III trial[J].J Hepatol,2012,57(4):821-829.
[22]Yamamoto Y,Matsui J,Matsushima T,et al.Lenvatinib,an angiogenesis inhibitor targeting VEGFR/FGFR,shows broad antitumor activity in human tumor xenograft models associated with microvessel density and pericyte coverage[J].Vasc Cell,2014,6:18.
[23]Matsui J,Yamamoto Y,Funahashi Y,et al.E7080,a novel inhibitor that targets multiple kinases,has potent antitumor activities against stem cell factor producing human small cell lung cancer H146,based on angiogenesis inhibition[J].Int J Cancer,2008,122(3):664-671.
[24]Yamada K,Yamamoto N,Yamada Y,et al.Phase I dose-escalation study and biomarker analysis of E7080 in patients with advanced solid tumors[J].Clin Cancer Res,2011,17(8):2528-2537.
[25]Kudo M,Finn RS,Qin S,et al.Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma:a randomised phase 3 non-inferiority trial[J].Lancet,2018,391(10126):1163-1173.