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.	赵明, 伍家鸣, 商昌珍, 等. 肝癌转化治疗相关技术方法及评价. 中国实用外科杂志, 2021, 41(3): 262-268.
4.	中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识 (2021版). 中国实用外科杂志, 2021, 41(6): 618-632.
5.	文天夫. 转化切除是提高肝细胞癌切除率的重要途径. 中国普外基础与临床杂志, 2020, 27(2): 133-136.
6.	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). 中华肝脏病杂志, 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.	宋天强, 刘雅月. 原发性肝癌转化治疗及其维持治疗策略. 中国实用外科杂志, 2021, 41(3): 269-272.
12.	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.
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.	张晓赟, 朱心睿, 彭伟, 等. 经肝动脉化疗栓塞+仑伐替尼+PD-1单抗在中晚期不可切除肝癌转化切除中的安全性和有效性的前瞻性队列研究: 初步报告. 中国普外基础与临床杂志, 2022, 29(1): 39-45.
17.	张泽, 曹银彪, 万涛, 等. 转化序贯外科手术方案治疗不可手术切除肝细胞癌的安全性与有效性分析. 中华肝胆外科杂志, 2022, 28(1): 15-20.
18.	罗德, 朱刚, 罗斌, 等. 2例肝癌综合降期治疗的MDT讨论. 中国普外基础与临床杂志, 2020, 27(5): 600-605.
19.	苗春木, 丁雄, 邓开, 等. MDT主导的BCLCB期肝右叶原发性巨块型肝癌TACE术后外科根治性切除的时机探讨. 中国普外基础与临床杂志, 2018, 25(6): 735-743.
20.	欧阳敬中, 卢俊, 王征征, 等. 晚期肝细胞癌多学科综合治疗1例. 中华外科杂志, 2022, 60(3): 266-267.
21.	杨季红, 陈国想, 周茉, 等. 肝细胞癌伴门静脉左支癌栓形成多学科综合治疗1例报告. 临床肝胆病杂志, 2021, 37(3): 666-669.
22.	国际肝胆胰协会中国分会, 中华医学会外科学分会肝脏外科学组, 中国临床肿瘤学会(CSCO) 肝癌专家委员会. 基于免疫节点抑制剂的肝细胞癌免疫联合治疗多学科中国专家共识 (2021版). 中华肝脏病杂志, 2021, 29(7): 636-647.
23.	中国医师协会肝癌专业委员会. 肝细胞癌合并胆管癌栓多学科诊治中国专家共识 (2020版). 中国实用外科杂志, 2021, 41(3): 241-247.
24.	中国医师协会肝癌专业委员会. 肝细胞癌合并肝静脉/下腔静脉癌栓多学科诊治中国专家共识 (2019版). 中华医学杂志, 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. 赵明, 伍家鸣, 商昌珍, 等. 肝癌转化治疗相关技术方法及评价. 中国实用外科杂志, 2021, 41(3): 262-268.
4. 中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识 (2021版). 中国实用外科杂志, 2021, 41(6): 618-632.
5. 文天夫. 转化切除是提高肝细胞癌切除率的重要途径. 中国普外基础与临床杂志, 2020, 27(2): 133-136.
6. 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). 中华肝脏病杂志, 2017, 25(12): 886-895.
7. 董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识 (2011版). 中华消化外科杂志, 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. 宋天强, 刘雅月. 原发性肝癌转化治疗及其维持治疗策略. 中国实用外科杂志, 2021, 41(3): 269-272.
12. 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.
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. 张晓赟, 朱心睿, 彭伟, 等. 经肝动脉化疗栓塞+仑伐替尼+PD-1单抗在中晚期不可切除肝癌转化切除中的安全性和有效性的前瞻性队列研究: 初步报告. 中国普外基础与临床杂志, 2022, 29(1): 39-45.
17. 张泽, 曹银彪, 万涛, 等. 转化序贯外科手术方案治疗不可手术切除肝细胞癌的安全性与有效性分析. 中华肝胆外科杂志, 2022, 28(1): 15-20.
18. 罗德, 朱刚, 罗斌, 等. 2例肝癌综合降期治疗的MDT讨论. 中国普外基础与临床杂志, 2020, 27(5): 600-605.
19. 苗春木, 丁雄, 邓开, 等. MDT主导的BCLCB期肝右叶原发性巨块型肝癌TACE术后外科根治性切除的时机探讨. 中国普外基础与临床杂志, 2018, 25(6): 735-743.
20. 欧阳敬中, 卢俊, 王征征, 等. 晚期肝细胞癌多学科综合治疗1例. 中华外科杂志, 2022, 60(3): 266-267.
21. 杨季红, 陈国想, 周茉, 等. 肝细胞癌伴门静脉左支癌栓形成多学科综合治疗1例报告. 临床肝胆病杂志, 2021, 37(3): 666-669.
22. 国际肝胆胰协会中国分会, 中华医学会外科学分会肝脏外科学组, 中国临床肿瘤学会(CSCO) 肝癌专家委员会. 基于免疫节点抑制剂的肝细胞癌免疫联合治疗多学科中国专家共识 (2021版). 中华肝脏病杂志, 2021, 29(7): 636-647.
23. 中国医师协会肝癌专业委员会. 肝细胞癌合并胆管癌栓多学科诊治中国专家共识 (2020版). 中国实用外科杂志, 2021, 41(3): 241-247.
24. 中国医师协会肝癌专业委员会. 肝细胞癌合并肝静脉/下腔静脉癌栓多学科诊治中国专家共识 (2019版). 中华医学杂志, 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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