Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2023; 11(19): 4664-4669
Published online Jul 6, 2023. doi: 10.12998/wjcc.v11.i19.4664
Hypothetical hypoxia-driven rapid disease progression in hepatocellular carcinoma post transarterial chemoembolization: A case report
Kai-Fuan Yeo, Amy Ker, Pei-En Kao, Chi-Chih Wang
Kai-Fuan Yeo, Chi-Chih Wang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
Amy Ker, Pei-En Kao, Chi-Chih Wang, School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
Author contributions: Yeo KF, Ker A, and Kao PE reviewed the literature and contributed to manuscript drafting; Wang CC were responsible for the revision and final approval of the manuscript; This article supported by Yeo KF, Yeo KF, and Ker A contributed equally to the manuscript as the first authors.
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 to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised in accordance with it.
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: Chi-Chih Wang, PhD, Associate Professor, Director, Division of Endoscopy, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110 Sec. 1, Jianguo N. Rd., Taichung 402306, Taiwan. bananaudwang@gmail.com
Received: February 18, 2023
Peer-review started: February 18, 2023
First decision: May 16, 2023
Revised: May 25, 2023
Accepted: June 6, 2023
Article in press: June 6, 2023
Published online: July 6, 2023
Abstract
BACKGROUND

Transarterial chemoembolization (TACE) is widely performed for intermediate-stage or unresectable hepatocellular carcinoma (HCC), but approximately half of patients do not respond to TACE treatment. We describe a case of rapidly progressing of HCC after TACE and provide a possible hypothesis for this condition. The finding may contribute to identifying patients who obtain less benefit from TACE, thus avoiding the unnecessary waste of medical resources and treatment during the golden hour window.

CASE SUMMARY

A 61-year-old woman had been diagnosed with chronic hepatitis B infection and HCC at Barcelona Clinic Liver Cancer stage B, which had been treated by segmental hepatectomy 14 mo ago. The tumor recurred in the two months after surgery. She received an initial TACE and then underwent systemic therapy with lenvatinib 8 mg daily due to an increased level of alpha-fetoprotein (AFP) after the first TACE. However, the tumor continued to progress with an increased level of AFP, and she underwent a second TACE, after which the tumor volume did not obviously decrease on the contrast-enhanced computed tomography image. One month later, she had a third TACE to control the residual HCC tumors. Two weeks after that, the HCC had increased dramatically with tea-colored urine and yellowish skin turgor. Eventually, the patient refused further treatment and went into hospice care.

CONCLUSION

Intense hypoxia induced by TACE can trigger rapid disease progression in infiltrative HCC patients with a large tumor burden

Keywords: Carcinoma, hepatocellular, Transarterial chemoembolization, Tumor hypoxia, Disease progression, Tumor burden, Case report

Core Tip: We report an hepatocellular carcinoma (HCC) case with a large tumor burden and infiltrative tumor pattern who exhibited rapidly increased tumor volume within two weeks after undergoing a third trans-arterial chemoembolization (TACE). Although the Barcelona Clinic Liver Cancer staging system classifies multinodular HCC without portal invasion or extrahepatic spread in stage B, it appears that TACE is not suitable for those with a large tumor burden or infiltrative tumor pattern. In addition, hypoxia is an important factor for tumor development, metastasis, and drug resistance. Our case suggests that intense hypoxia induced by TACE may lead to the rapid progression of HCC.