MDT discussion of comprehensive downstaging treatment for 2 cases of liver cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO De ^1,2 , ZHU Gang ^1,2 , LUO Bin ^1,2 , XIE Yunchuan ³ , HAN Yunwei ⁴ , PENG Fangyi ^1,2 , FANG Cheng ^1,2 , GAN Yu ^1,2 , YANG Xiaoli ^1,2 , SU Song ^1,2 ,  LI Bo ^1,2

1. Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan 646000, P. R. China;
3. Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
4. Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

LI Bo, Email: liboer2002@126.com

Keywords：

liver cancer; comprehensive treatment; downstaging treatment; multidisciplinary team

DOI：

10.7507/1007-9424.201912064

Video：

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Objective To explore value of multidisciplinary team (MDT) discussion in comprehensive downstaging treatment of liver cancer.Method The clinical data of 2 patients with liver cancer who could not undergo the radical surgery admitted to the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.Results Case 1 was diagnosed as the liver cancer with extensive double lung metastasis at admission. The clinical stage was stage Ⅲb; After MDT discussion, the patient was treated with chemotherapy and embolization via hepatic artery and bronchial artery; At the same time, the patient was treated with apatinib; At present, the metastasis of both lungs disappeared completely; The clinical stage was stage ⅡB, and the radical resection was proposed. Case 2 was diagnosed as the right liver cancer at admission. The clinical stage was stage Ⅰ b. The preoperative examination showed that the hepatic reserve function was poor and the patient could not tolerate the half hepatectomy; After MDT discussion, the patient was treated with the combination of chemotherapy and embolization via the hepatic artery and apatinib in the same period; At the same time, the patient was treated with liver protection. The clinical stage was reduced to stage Ⅰ a. The hepatic reserve function improved and the laparoscopic right hemihepatectomy was performed, no recurrence or metastasis was found after 3 months follow-up.Conclusion Comprehensive downstaging treatment based on MDT model could bring better clinical outcomes for patients with liver cancer who are unable to undergo one-stage radical surgery.

Citation： LUO De, ZHU Gang, LUO Bin, XIE Yunchuan, HAN Yunwei, PENG Fangyi, FANG Cheng, GAN Yu, YANG Xiaoli, SU Song, LI Bo. MDT discussion of comprehensive downstaging treatment for 2 cases of liver cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 600-605. doi: 10.7507/1007-9424.201912064 Copy

1.	李川江, 周杰. 肝细胞肝癌经肝动脉化疗栓塞联合索拉非尼降期后二期切除的初步报告. 腹部外科, 2017, 30(4): 295-298, 301.
2.	金鑫, 史宪杰, 王茂强, 等. 大肝癌 58 例患者经肝动脉插管化疗栓塞降期治疗体会. 中华医学杂志, 2011, 91(14): 950-955.
3.	赖俊雄, 刘晓欣, 刘允怡. 原发性肝癌降期手术新进展. 临床外科杂志, 2015, 23(1): 5-7.
4.	王浩, 陈光, 高海军, 等. 载药微球介入栓塞治疗在肝癌肝移植术前降期治疗中的应用. 中华普通外科杂志, 2019, 34(5): 410-412.
5.	中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017 年版). 中华消化外科杂志, 2017, 16(7): 635-647.
6.	蔡秀军, 郑强, 蒋广宜. 肝癌外科治疗的现状和展望. 中华外科杂志, 2019, 57(7): 494-499.
7.	Lewandowski RJ, Kulik LM, Riaz A, et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant, 2009, 9(8): 1920-1928.
8.	尹伟利, 连佳, 肖时湘, 等. 载药微球与传统碘化油经肝动脉化疗栓塞术治疗不可切除肝癌效果比较的 Meta 分析. 临床肝胆病杂志, 2019, 35(6): 1270-1275.
9.	邱力戈, 梁若斯, 李勇, 等. HepaSphere 载药微球与碘油化疗栓塞大肝癌的不良反应比较. 中华介入放射学电子杂志, 2018, 6(2): 99-103.
10.	林继平, 肖亦明, 唐承富. 载药微球与碘化油在肝癌栓塞治疗中的疗效及并发症对比研究. 中国实用医药, 2019, 14(22): 40-41.
11.	曹国洪, 王凯, 李佳琪, 等. CalliSphere®载药微球经动脉导管化疗栓塞治疗肝癌患者的有效性及安全性分析. 中国介入影像与治疗学, 2018, 15(1): 42-46.
12.	张锡武, 陈莹, 黄娟, 等. CalliSpheres®载药微球化学栓塞治疗中早期肝细胞癌患者的疗效、安全性及预后因素分析. 第二军医大学学报, 2019, 40(4): 399-407.
13.	中国医师协会介入医师分会. 中国肝细胞癌经动脉化疗栓塞治疗(TACE)临床实践指南. 中华肝脏病杂志, 2019, 27(3): 172-181.
14.	王浩, 陈光, 高海军, 等. 载药微球化疗栓塞在肝癌患者肝移植等待期间应用的疗效分析. 中华肝胆外科杂志, 2019, 25(4): 246-248.
15.	黎莹, 杨冬阳, 赖晓嵘, 等. 阿帕替尼联合 TACE 对肝癌患者 AFP、VEGF 和 CEA 的影响. 肝脏, 2018, 23(5): 426-430.
16.	杨庆, 潘松松, 施昌盛, 等. 甲磺酸阿帕替尼联合 TACE 治疗中晚期肝癌的效果及对患者血清 VEGF 和 MMP-9 的影响. 中华介入放射学电子杂志, 2019, 7(2): 111-116.
17.	吴发宗, 吕秀玲, 宋晶晶, 等. 阿帕替尼联合肝动脉化疗栓塞术的抗肝癌疗效及对肿瘤血管再生的影响. 温州医科大学学报, 2019, 49(6): 423-426, 431.
18.	谢佳杭, 王久惠. 索拉菲尼联合 TACE 治疗进展期原发性肝癌疗效及并发症分析. 肿瘤预防与治疗, 2015, 28(3): 152-154.
19.	吴金道, 韩国勇, 陆森, 等. 肝动脉栓塞化疗术联合索拉菲尼对比单纯介入术治疗原发性肝癌的临床观察. 南京医科大学学报(自然科学版), 2015, 35(12): 1739-1742.
20.	Liu GM, Huang XY, Shen SL, et al. Adjuvant antiviral therapy for hepatitis B virus-related hepatocellular carcinoma after curative treatment: A systematic review and meta-analysis. Hepatol Res, 2016, 46(1): 100-110.
21.	Chen XX, Cheng JW, Huang A, et al. The effect of antiviral therapy on patients with hepatitis B virus-related hepatocellular carcinoma after curative resection: a systematic review and meta-analysis. Onco Targets Ther, 2017, 10: 5363-5375.
22.	徐建波, 张建淮, 宋研, 等. 经导管肝动脉栓塞化疗联合抗病毒治疗对乙肝相关肝癌患者复发的影响. 中华肝胆外科杂志, 2018, 24(9): 590-593.
23.	Sinn DH, Choi GS, Park HC, et al. Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients. PLoS One, 2019, 14(1): e0210730.

1. 李川江, 周杰. 肝细胞肝癌经肝动脉化疗栓塞联合索拉非尼降期后二期切除的初步报告. 腹部外科, 2017, 30(4): 295-298, 301.
2. 金鑫, 史宪杰, 王茂强, 等. 大肝癌 58 例患者经肝动脉插管化疗栓塞降期治疗体会. 中华医学杂志, 2011, 91(14): 950-955.
3. 赖俊雄, 刘晓欣, 刘允怡. 原发性肝癌降期手术新进展. 临床外科杂志, 2015, 23(1): 5-7.
4. 王浩, 陈光, 高海军, 等. 载药微球介入栓塞治疗在肝癌肝移植术前降期治疗中的应用. 中华普通外科杂志, 2019, 34(5): 410-412.
5. 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017 年版). 中华消化外科杂志, 2017, 16(7): 635-647.
6. 蔡秀军, 郑强, 蒋广宜. 肝癌外科治疗的现状和展望. 中华外科杂志, 2019, 57(7): 494-499.
7. Lewandowski RJ, Kulik LM, Riaz A, et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant, 2009, 9(8): 1920-1928.
8. 尹伟利, 连佳, 肖时湘, 等. 载药微球与传统碘化油经肝动脉化疗栓塞术治疗不可切除肝癌效果比较的 Meta 分析. 临床肝胆病杂志, 2019, 35(6): 1270-1275.
9. 邱力戈, 梁若斯, 李勇, 等. HepaSphere 载药微球与碘油化疗栓塞大肝癌的不良反应比较. 中华介入放射学电子杂志, 2018, 6(2): 99-103.
10. 林继平, 肖亦明, 唐承富. 载药微球与碘化油在肝癌栓塞治疗中的疗效及并发症对比研究. 中国实用医药, 2019, 14(22): 40-41.
11. 曹国洪, 王凯, 李佳琪, 等. CalliSphere®载药微球经动脉导管化疗栓塞治疗肝癌患者的有效性及安全性分析. 中国介入影像与治疗学, 2018, 15(1): 42-46.
12. 张锡武, 陈莹, 黄娟, 等. CalliSpheres®载药微球化学栓塞治疗中早期肝细胞癌患者的疗效、安全性及预后因素分析. 第二军医大学学报, 2019, 40(4): 399-407.
13. 中国医师协会介入医师分会. 中国肝细胞癌经动脉化疗栓塞治疗(TACE)临床实践指南. 中华肝脏病杂志, 2019, 27(3): 172-181.
14. 王浩, 陈光, 高海军, 等. 载药微球化疗栓塞在肝癌患者肝移植等待期间应用的疗效分析. 中华肝胆外科杂志, 2019, 25(4): 246-248.
15. 黎莹, 杨冬阳, 赖晓嵘, 等. 阿帕替尼联合 TACE 对肝癌患者 AFP、VEGF 和 CEA 的影响. 肝脏, 2018, 23(5): 426-430.
16. 杨庆, 潘松松, 施昌盛, 等. 甲磺酸阿帕替尼联合 TACE 治疗中晚期肝癌的效果及对患者血清 VEGF 和 MMP-9 的影响. 中华介入放射学电子杂志, 2019, 7(2): 111-116.
17. 吴发宗, 吕秀玲, 宋晶晶, 等. 阿帕替尼联合肝动脉化疗栓塞术的抗肝癌疗效及对肿瘤血管再生的影响. 温州医科大学学报, 2019, 49(6): 423-426, 431.
18. 谢佳杭, 王久惠. 索拉菲尼联合 TACE 治疗进展期原发性肝癌疗效及并发症分析. 肿瘤预防与治疗, 2015, 28(3): 152-154.
19. 吴金道, 韩国勇, 陆森, 等. 肝动脉栓塞化疗术联合索拉菲尼对比单纯介入术治疗原发性肝癌的临床观察. 南京医科大学学报(自然科学版), 2015, 35(12): 1739-1742.
20. Liu GM, Huang XY, Shen SL, et al. Adjuvant antiviral therapy for hepatitis B virus-related hepatocellular carcinoma after curative treatment: A systematic review and meta-analysis. Hepatol Res, 2016, 46(1): 100-110.
21. Chen XX, Cheng JW, Huang A, et al. The effect of antiviral therapy on patients with hepatitis B virus-related hepatocellular carcinoma after curative resection: a systematic review and meta-analysis. Onco Targets Ther, 2017, 10: 5363-5375.
22. 徐建波, 张建淮, 宋研, 等. 经导管肝动脉栓塞化疗联合抗病毒治疗对乙肝相关肝癌患者复发的影响. 中华肝胆外科杂志, 2018, 24(9): 590-593.
23. Sinn DH, Choi GS, Park HC, et al. Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients. PLoS One, 2019, 14(1): e0210730.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT discussion of comprehensive downstaging treatment for 2 cases of liver cancer

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