Conversion therapy of giant liver cancer: a case of MDT discussion_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Xin ^1,2 , GAO Fengwei ^1,2 ,  LEI Zehua ^1,2 , XIE Qingyun ^1,2 , JIANG Kangyi ^1,2 , GAO Benjian ^1,2 , WANG Tao ³ , FAN Hua ⁴

1. Department of Hepatobiliary and Pancreatic Surgery, People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;
2. Diagnosis and Treatment Center of Hepatobiliary Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan 614000, P. R. China;
3. Department of Radiology, People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;
4. Department of Oncology, People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

LEI Zehua, Email: leitsehua@126.com

Keywords：

liver cancer; conversion therapy; multidisciplinary team

DOI：

10.7507/1007-9424.202204010

Video：

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Objective To investigate the value of multidisciplinary team (MDT) diagnosis and treatment model in the conversion therapy of liver cancer. Method The clinical data of a patient with high-risk giant liver cancer of the right liver who was admitted to People’s Hospital of Leshan in April 2019, and who was successfully conversion therapy and safely underwent hepatectomy after MDT discussion was retrospectively analyzed. Results A 62 years old male patient was admitted to our hospital with “abdominal distension for more than 1 month, and liver mass was found for 10 days”. The relevant auxiliary examinations were perfected. The patient was diagnosed as huge primary hepatocellular carcinoma in the right liver. One-stage surgical resection cannot be performed safely due to the huge tumor. After MDT discussion, transcatheter arterial chemoembolization (TACE) combined with sorafenib targeted therapy was decided to reduce the lesions, and two-stage surgical resection was performed safely after conversion therapy. After two cycles of TACE combined with sorafenib targeted drug therapy, MDT discussed the feasibility of safe surgical resection, and underwent fluorescence-guided laparoscopic right posterior lobectomy. The postoperative pathological examination revealed moderately differentiated hepatocellular carcinoma. The patient recovered and was discharged from the hospital one week later. Outpatient followed-up for 32 months showed no obvious abnormality. Conclusions MDT discussion can formulate a more individualized treatment plan, improve the conversion rate and resectable rate of advanced liver cancer, and has important value in the diagnosis and treatment of advanced liver cancer.

Citation： ZHAO Xin, GAO Fengwei, LEI Zehua, XIE Qingyun, JIANG Kangyi, GAO Benjian, WANG Tao, FAN Hua. Conversion therapy of giant liver cancer: a case of MDT discussion. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 1024-1028. doi: 10.7507/1007-9424.202204010 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
3.	趙明, 伍家鳴, 商昌珍, 等. 肝癌轉化治療相關技術方法及評價. 中國實用外科雜志, 2021, 41(3): 262-268.
4.	中國抗癌協會肝癌專業委員會轉化治療協作組. 肝癌轉化治療中國專家共識 (2021版). 中國實用外科雜志, 2021, 41(6): 618-632.
5.	文天夫. 轉化切除是提高肝細胞癌切除率的重要途徑. 中國普外基礎與臨床雜志, 2020, 27(2): 133-136.
6.	中華人民共和國衛生和計劃生育委員會醫政醫管局. 原發性肝癌診療規范 (2017年版). 中華肝臟病雜志, 2017, 25(12): 886-895.
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8.	Llovet JM, Lencioni R. mRECIST for HCC: Performance and novel refinements. J Hepatol, 2020, 72(2): 288-306.
9.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
10.	Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
11.	宋天強, 劉雅月. 原發性肝癌轉化治療及其維持治療策略. 中國實用外科雜志, 2021, 41(3): 269-272.
12.	李川江, 周杰. 肝細胞肝癌經肝動脈化療栓塞聯合索拉非尼降期后二期切除的初步報告. 腹部外科, 2017, 30(4): 295-298, 301.
13.	He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: A randomized clinical trial. JAMA Oncol, 2019, 5(7): 953-960.
14.	Lee HS, Choi GH, Choi JS, et al. Surgical resection after down-staging of locally advanced hepatocellular carcinoma by localized concurrent chemoradiotherapy. Ann Surg Oncol, 2014, 21(11): 3646-3653.
15.	Chong JU, Choi GH, Han DH, et al. Downstaging with localized concurrent chemoradiotherapy can identify optimal surgical candidates in hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol, 2018, 25(11): 3308-3315.
16.	張曉赟, 朱心睿, 彭偉, 等. 經肝動脈化療栓塞+侖伐替尼+PD-1單抗在中晚期不可切除肝癌轉化切除中的安全性和有效性的前瞻性隊列研究: 初步報告. 中國普外基礎與臨床雜志, 2022, 29(1): 39-45.
17.	張澤, 曹銀彪, 萬濤, 等. 轉化序貫外科手術方案治療不可手術切除肝細胞癌的安全性與有效性分析. 中華肝膽外科雜志, 2022, 28(1): 15-20.
18.	羅德, 朱剛, 羅斌, 等. 2例肝癌綜合降期治療的MDT討論. 中國普外基礎與臨床雜志, 2020, 27(5): 600-605.
19.	苗春木, 丁雄, 鄧開, 等. MDT主導的BCLCB期肝右葉原發性巨塊型肝癌TACE術后外科根治性切除的時機探討. 中國普外基礎與臨床雜志, 2018, 25(6): 735-743.
20.	歐陽敬中, 盧俊, 王征征, 等. 晚期肝細胞癌多學科綜合治療1例. 中華外科雜志, 2022, 60(3): 266-267.
21.	楊季紅, 陳國想, 周茉, 等. 肝細胞癌伴門靜脈左支癌栓形成多學科綜合治療1例報告. 臨床肝膽病雜志, 2021, 37(3): 666-669.
22.	國際肝膽胰協會中國分會, 中華醫學會外科學分會肝臟外科學組, 中國臨床腫瘤學會(CSCO) 肝癌專家委員會. 基于免疫節點抑制劑的肝細胞癌免疫聯合治療多學科中國專家共識 (2021版). 中華肝臟病雜志, 2021, 29(7): 636-647.
23.	中國醫師協會肝癌專業委員會. 肝細胞癌合并膽管癌栓多學科診治中國專家共識 (2020版). 中國實用外科雜志, 2021, 41(3): 241-247.
24.	中國醫師協會肝癌專業委員會. 肝細胞癌合并肝靜脈/下腔靜脈癌栓多學科診治中國專家共識 (2019版). 中華醫學雜志, 2020, 100(20): 1532-1538.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
3. 趙明, 伍家鳴, 商昌珍, 等. 肝癌轉化治療相關技術方法及評價. 中國實用外科雜志, 2021, 41(3): 262-268.
4. 中國抗癌協會肝癌專業委員會轉化治療協作組. 肝癌轉化治療中國專家共識 (2021版). 中國實用外科雜志, 2021, 41(6): 618-632.
5. 文天夫. 轉化切除是提高肝細胞癌切除率的重要途徑. 中國普外基礎與臨床雜志, 2020, 27(2): 133-136.
6. 中華人民共和國衛生和計劃生育委員會醫政醫管局. 原發性肝癌診療規范 (2017年版). 中華肝臟病雜志, 2017, 25(12): 886-895.
7. 董家鴻, 鄭樹森, 陳孝平, 等. 肝切除術前肝臟儲備功能評估的專家共識 (2011版). 中華消化外科雜志, 2011, 10(1): 20-25.
8. Llovet JM, Lencioni R. mRECIST for HCC: Performance and novel refinements. J Hepatol, 2020, 72(2): 288-306.
9. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
10. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
11. 宋天強, 劉雅月. 原發性肝癌轉化治療及其維持治療策略. 中國實用外科雜志, 2021, 41(3): 269-272.
12. 李川江, 周杰. 肝細胞肝癌經肝動脈化療栓塞聯合索拉非尼降期后二期切除的初步報告. 腹部外科, 2017, 30(4): 295-298, 301.
13. He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: A randomized clinical trial. JAMA Oncol, 2019, 5(7): 953-960.
14. Lee HS, Choi GH, Choi JS, et al. Surgical resection after down-staging of locally advanced hepatocellular carcinoma by localized concurrent chemoradiotherapy. Ann Surg Oncol, 2014, 21(11): 3646-3653.
15. Chong JU, Choi GH, Han DH, et al. Downstaging with localized concurrent chemoradiotherapy can identify optimal surgical candidates in hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol, 2018, 25(11): 3308-3315.
16. 張曉赟, 朱心睿, 彭偉, 等. 經肝動脈化療栓塞+侖伐替尼+PD-1單抗在中晚期不可切除肝癌轉化切除中的安全性和有效性的前瞻性隊列研究: 初步報告. 中國普外基礎與臨床雜志, 2022, 29(1): 39-45.
17. 張澤, 曹銀彪, 萬濤, 等. 轉化序貫外科手術方案治療不可手術切除肝細胞癌的安全性與有效性分析. 中華肝膽外科雜志, 2022, 28(1): 15-20.
18. 羅德, 朱剛, 羅斌, 等. 2例肝癌綜合降期治療的MDT討論. 中國普外基礎與臨床雜志, 2020, 27(5): 600-605.
19. 苗春木, 丁雄, 鄧開, 等. MDT主導的BCLCB期肝右葉原發性巨塊型肝癌TACE術后外科根治性切除的時機探討. 中國普外基礎與臨床雜志, 2018, 25(6): 735-743.
20. 歐陽敬中, 盧俊, 王征征, 等. 晚期肝細胞癌多學科綜合治療1例. 中華外科雜志, 2022, 60(3): 266-267.
21. 楊季紅, 陳國想, 周茉, 等. 肝細胞癌伴門靜脈左支癌栓形成多學科綜合治療1例報告. 臨床肝膽病雜志, 2021, 37(3): 666-669.
22. 國際肝膽胰協會中國分會, 中華醫學會外科學分會肝臟外科學組, 中國臨床腫瘤學會(CSCO) 肝癌專家委員會. 基于免疫節點抑制劑的肝細胞癌免疫聯合治療多學科中國專家共識 (2021版). 中華肝臟病雜志, 2021, 29(7): 636-647.
23. 中國醫師協會肝癌專業委員會. 肝細胞癌合并膽管癌栓多學科診治中國專家共識 (2020版). 中國實用外科雜志, 2021, 41(3): 241-247.
24. 中國醫師協會肝癌專業委員會. 肝細胞癌合并肝靜脈/下腔靜脈癌栓多學科診治中國專家共識 (2019版). 中華醫學雜志, 2020, 100(20): 1532-1538.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Conversion therapy of giant liver cancer: a case of MDT discussion

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