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
Processing time: 131 Days and 20.4 Hours
Core Tip

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.