多纳非尼联合HAIC和信迪利单抗治疗伴下腔静脉癌栓的肝细胞癌并完全缓解一例

doi:10.11958/20221916

天津医药 ›› 2023, Vol. 51 ›› Issue (2): 203-206.doi: 10.11958/20221916

多纳非尼联合HAIC和信迪利单抗治疗伴下腔静脉癌栓的肝细胞癌并完全缓解一例

张伟¹(), 高炜²^,^△(), 刘晨¹, 刘潇濛¹, 张钦¹

1 天津医科大学肿瘤医院肝胆外科，天津医科大学肿瘤医院肝癌防治研究中心，国家肿瘤临床医学研究中心，天津市“肿瘤防治”重点实验室，天津市恶性肿瘤临床医学研究中心（邮编300060）
2 天津医科大学肿瘤医院介入治疗科，天津医科大学肿瘤医院肝癌防治研究中心，国家肿瘤临床医学研究中心，天津市“肿瘤防治”重点实验室，天津市恶性肿瘤临床医学研究中心（邮编300060）

收稿日期:2022-11-20 修回日期:2022-12-05 出版日期:2023-02-15 发布日期:2023-02-24
通讯作者: ^△E-mail：doctorgao99@163.com
作者简介:张伟（1982），男，博士，副主任医师，主要从事肝胆恶性肿瘤外科基础临床转化方面研究。E-mail：zhangweitjch@163.com
基金资助:
天津市教委社会科学重大项目(2018JWZD34)

Donafenib combined with HAIC and sintilimab for hepatocellular carcinoma with tumor thrombus in inferior vena cava and achieved complete remission: a case report

ZHANG Wei¹(), GAO Wei²^,^△(), LIU Chen¹, LIU Xiaomeng¹, ZHANG Qin¹

1 Department of Hepatobiliary Surgery, Research Center for Prevention and Treatment of Liver Cancer; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
2 Department of Interventional Therapy, Research Center for Prevention and Treatment of Liver Cancer; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China

Received:2022-11-20 Revised:2022-12-05 Published:2023-02-15 Online:2023-02-24
Contact: ^△E-mail：doctorgao99@163.com

张伟, 高炜, 刘晨, 刘潇濛, 张钦. 多纳非尼联合HAIC和信迪利单抗治疗伴下腔静脉癌栓的肝细胞癌并完全缓解一例[J]. 天津医药, 2023, 51(2): 203-206.

ZHANG Wei, GAO Wei, LIU Chen, LIU Xiaomeng, ZHANG Qin. Donafenib combined with HAIC and sintilimab for hepatocellular carcinoma with tumor thrombus in inferior vena cava and achieved complete remission: a case report[J]. Tianjin Medical Journal, 2023, 51(2): 203-206.

摘要/Abstract

摘要：

目的探讨多纳非尼联合肝动脉灌注化疗（HAIC）和抗PD-1抗体信迪利单抗对肝细胞癌合并下腔静脉癌栓患者的疗效。方法 1例肝细胞癌合并下腔静脉近右心房癌栓的患者，接受多纳非尼联合HAIC和信迪利单抗治疗。通过实体瘤的疗效评价标准RECIST v1.1评估肿瘤治疗反应情况，观察甲胎蛋白（AFP）和异常凝血酶原（PIVKA-Ⅱ）指标符合要求后，进行手术治疗。结果经过多纳非尼联合HAIC和信迪利单抗治疗4个周期后，成功缩小肝脏肿瘤及下腔静脉癌栓，AFP降至正常。采用全肝血流阻断法和下腔静脉切开取栓术完整切除肝脏肿瘤及癌栓，手术获得成功。术后病理提示肿瘤完全缓解。结论多纳非尼联合HAIC和信迪利单抗可作为治疗肝癌合并下腔静脉癌栓患者的转化治疗方案。

关键词: 癌, 肝细胞, 多纳非尼, 肝动脉灌注化疗, 转化治疗, 下腔静脉癌栓

Abstract:

Objective To investigate the effect of hepatic artery infusion chemotherapy combined with targeted and immunotherapy on hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT). Methods A case of hepatocellular carcinoma with tumor thrombus in the inferior vena cava (IVC) near the right atrium was treated with donafenib combined with hepatic artery infusion chemotherapy (HAIC) and sintilimab. The response of tumor treatment was evaluated by RECEST v1.1. The dynamic changes of alpha-fetoprotein (AFP) and PIVKA-Ⅱ were observed and the surgical procedure was introduced. Results After four cycles of treatment with donafenib combined with HAIC and sintilimab, the diameter of the tumor and the tumor thrombus in IVC were successfully reduced, and AFP was reduced to normal. Both tumor and tumor thrombus were completely removed by total hepatic vascular exclusion (THVE) with the IVC incision. Postoperative pathology showed complete remission of the tumor. Conclusion Donafenib combined with HAIC and sintilimab has a good tumor shrinking effect for HCC with IVCTT, and can be applied for conversion surgery for patients of HCC with IVCTT.

Key words: carcinoma, hepatocellular, donafenib, HAIC, conversion therapy, IVCTT

中图分类号:

R735.7

图/表 4

图1 患者肿瘤治疗前后的MRI影像结果 A：4月21日治疗前肝癌合并下腔静脉癌栓；B：8月11日治疗后下腔静脉癌栓缩小，强化减弱；C：4月21日治疗前肝左叶肿瘤直径7.8 cm； D：8月11日治疗后肝左叶肿瘤明显缩小，同时肝左静脉癌栓退缩、强化减弱，下腔静脉内癌栓明显缩小。

Fig.1 MRI features of a patient before and after tumor treatment

图2 术中肝脏肿瘤和腹腔结节大体观察 A：肿瘤明显缩小，呈灰白色；B：大网膜多发粟粒样结节；C：胃窦下方、十二指肠和胰头前方直径6 cm质硬结节；D：胰头前方结节切除后。

Fig.2 General observation of liver tumor and abdominal nodule during operation

图3 术中采用全肝血流阻断技术切除左半肝及肿瘤并完整取出癌栓 A：肝上下腔静脉阻断；B：肝下下腔静脉阻断和第一肝门阻断；C：打开肝左静脉及下腔静脉，将癌栓取出；D：左半肝切除后的创面情况。

Fig.3 During the operation the left liver and tumor were removed by whole hepatic vascular exclusion technique and tumor thrombus was resected completely

图4 术后病理情况 A：肝脏及肿物大体观；B：十二指肠胰头前方结节剖面观；C：低倍镜下肿瘤组织坏死及炎症细胞浸润明显（HE染色×40）；D：高倍镜下可见大量炎性细胞浸润，未见活性肿瘤组织（HE染色×100）。

Fig.4 Pathological changes after operation

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多纳非尼联合HAIC和信迪利单抗治疗伴下腔静脉癌栓的肝细胞癌并完全缓解一例

Donafenib combined with HAIC and sintilimab for hepatocellular carcinoma with tumor thrombus in inferior vena cava and achieved complete remission: a case report

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