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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy: A case report and review of literature
Ju-Hang Chu, Lu-Yao Huang, Ya-Ru Wang, Jun Li, Shi-Long Han, Hao Xi, Wen-Xue Gao, Ying-Yu Cui, Ming-Ping Qian
Ju-Hang Chu, Lu-Yao Huang, Ya-Ru Wang, Jun Li, Ming-Ping Qian, Department of General Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
Shi-Long Han, Department of Interventional and Vascular Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
Hao Xi, Department of Pathology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
Wen-Xue Gao, Clinical Research Management Office, Shanghai Tenth People’s Hospital, Shanghai 200072, China
Ying-Yu Cui, Department of Cell Biology, Institute of Medical Genetics, State Key Laboratory of Cardiology, Tongji University School of Medicine, Shanghai 200331, China
Co-corresponding authors: Ying-Yu Cui and Ming-Ping Qian.
Author contributions: Chu JH, Huang LY and Wang YR collected the pathological, biological, and clinical data; Chu JH drafted the initial manuscript; Han SL and Xi H reviewed the pathological results; Li J, Gao WX, Cui YY and Qian MP reviewed or revised the manuscript and approved the final version; Qian MP had full access to all the data and had final responsibility for the decision to submit for publication; and all the authors contributed to the article and approved the final manuscript. Qian MP and Cui YY contributed equally to this work as co-corresponding authors. The reasons for designating Qian MP and Cui YY as co-corresponding authors are threefold. Qian MP had full access to all the data and had final responsibility for the decision to submit for publication; and all the authors contributed to the article and approved the final manuscript. In addition, Cui YY ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability.
Supported by Shanghai Hospital Development Center Foundation, No. SHDC2022CRS033.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ying-Yu Cui, PhD, Associate Professor, Editor-in-Chief, Teacher, Department of Cell Biology, Institute of Medical Genetics, State Key Laboratory of Cardiology, Tongji University School of Medicine, No. 500 Zhennan Road, Putuo District, Shanghai 200331, China. yycui@tongji.edu.cn
Received: November 18, 2023
Peer-review started: November 18, 2023
First decision: December 22, 2023
Revised: January 8, 2024
Accepted: February 19, 2024
Article in press: February 19, 2024
Published online: April 15, 2024
BACKGROUND
Hepatocellular carcinoma (HCC) is one of the leading causes of death due to its complexity, heterogeneity, rapid metastasis and easy recurrence after surgical resection. We demonstrated that combination therapy with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), Epclusa, Lenvatinib and Sintilimab is useful for patients with advanced HCC.
CASE SUMMARY
A 69-year-old man who was infected with hepatitis C virus (HCV) 30 years previously was admitted to the hospital with abdominal pain. Enhanced computed tomography (CT) revealed a low-density mass in the right lobe of the liver, with a volume of 12.9 cm × 9.4 cm × 15 cm, and the mass exhibited a “fast-in/fast-out” pattern, with extensive filling defect areas in the right branch of the portal vein and an alpha-fetoprotein level as high as 657 ng/mL. Therefore, he was judged to have advanced HCC. During treatment, the patient received three months of Epclusa, three TACE treatments, two HAIC treatments, three courses of sintilimab, and twenty-one months of lenvatinib. In the third month of treatment, the patient developed severe side effects and had to stop immunotherapy, and the Lenvatinib dose had to be halved. Postoperative pathological diagnosis indicated a complete response. The patient recovered well after the operation, and no tumor recurrence was found.
CONCLUSION
Multidisciplinary conversion therapy for advanced enormous HCC caused by HCV infection has a significant effect. Individualized drug adjustments should be made during any treatment according to the patient's tolerance to treatment.
Core Tip: The present study describes the excellent efficacy of conversion therapy including interventional therapy, anti-hepatitis C virus therapy, and immunotargeted therapy for advanced giant hepatocellular carcinoma (HCC). After 21 months of conversion therapy, the patient underwent surgical resection completely and the postoperative pathology suggested a complete response. In summary, conversion therapy is a promising treatment option for unresectable HCC patients.
