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岭南现代临床外科 ›› 2021, Vol. 21 ›› Issue (05): 507-511.DOI: 10.3969/j.issn.1009-976X.2021.05.003

• 病例解读 • 上一篇    下一篇

介入联合仑伐替尼桥接治疗超米兰标准肝癌肝移植2例报道

鲁旭1, 李华1, 易述红1, 赵辉1, 朱曙光1, 李海波1, 杨扬1, 汪国营1,2,*   

  1. 1.中山大学附属第三医院肝脏外科暨肝脏移植中心,广州 510630;
    2.广州医科大学附属第一医院肝胆外科,广州 510120
  • 通讯作者: *汪国营,Email: wanggy3@126.com
  • 作者简介:汪国营,医学博士,主任医师,博士生导师。
    现任广州医科大学附属第一医院肝胆外科执行主任,擅长肝胆胰脾外科疑难危重疾病的诊治、复杂肝胆胰脾外科及肝脏移植手术,在腔镜微创外科技术、肝癌的规范化综合诊治、门脉高压症的外科治疗、肝移植的原发病复发和并发症防治等方面有丰富经验。
    兼任中国医师协会器官移植医师分会委员及移植管理学组委员、中国研究型医院学会普通外科学青年委员会副主任委员、广州市医师协会肝胆胰外科医师分会主任委员、广东省肝脏病学会器官移植专业委员会副主任委员、广州市医师协会普通外科微创专业医师分会副主任委员、广东省医学会肝胆胰外科学分会常委、中华消化外科菁英会移植外科学组副组长,国家自然科学基金、广东省高层次人才、教育部学位中心学位论文评审专家。《Frontiers in Oncology》《中华肝脏外科手术学电子杂志》《器官移植》《岭南现代临床外科》等杂志编委。
    入选首届树兰卓越工程器官移植青年人才、首批广东省杰出青年医学人才;曾获国际肝移植协会青年研究者奖3次、美国移植协会青年创新者奖、欧洲肝脏研究学会青年研究者奖、亚洲移植协会旅行奖等多项国际性奖励,是我国器官移植领域获国际性奖励最多的青年学者之一;2015年获广东省科学技术进步奖一等奖(R5)。承担国家自然科学基金2项以及省市级科研项目多项,第一作者或通讯作者发表SCI论文30余篇及中文核心期刊论文60余篇;参编专著及本科生规划教材6部,参编国家级行业指南或共识5部,获国家发明专利1项。
  • 基金资助:
    十三五科技重大专项(2017ZX10203205-006-001); 陈孝平科技发展基金(CXPJJH12000001-2020218)

Transarterial chemoembolization combined with Lenvatinib bridging in the treatment of 2 patients with hepatocellular carcinoma exceeding Milan standard liver transplantation

LU Xu1, LI Hua1, YI Shu-hong1, ZHAO Hui1, ZHU Shu-guang1, LI Hai-bo1, YANG Yang1, WANG Guo-ying1,2   

  1. 1. Department of Hepatic Surgery, Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China;
    2. Department of Hepatic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
  • Online:2021-10-20 Published:2022-01-19
  • Contact: WANG Guo-ying, wanggy3@126.com

摘要: 目的 探究超米兰标准肝癌肝移植术前肝癌降期或桥接治疗的新方案,评价介入联合仑伐替尼治疗超米兰标准肝癌后实施肝移植的安全性和疗效。方法 回顾性分析我中心2例超米兰标准肝癌通过介入治疗联合仑伐替尼靶向治疗后成功接受肝移植患者的临床资料,术后规律复查血清学标记物、CT检查或肝脏彩超等评估患者的预后及肿瘤复发情况,评估该桥接方案的安全性和疗效。结果 第一例患者为肝癌伴门静脉右前支癌栓,为我国肝癌分期(CNLC分期)Ⅲa期,通过介入联合仑伐替尼治疗2个月,患者接受同种异体原位肝移植术,术后切口愈合良好,痊愈出院,术后病理提示肿瘤绝大部分坏死,仅周围见少许异形细胞团,规律随访16个月,未见肿瘤复发。第二例患者为肝癌伴肝中静脉侵犯,为CNLC分期Ⅲa期,通过介入联合仑伐替尼治疗1个月,肿瘤学评价为SD,患者接受同种异体原位肝移植术,术后切口愈合良好,痊愈出院,术后病理提示绝大部分组织已坏死,仅见少量肿瘤细胞呈条索样、腺样排列,规律随访14个月,未见肿瘤复发。两例患者目前肝功能正常,无其他并发症发生。结论 介入治疗联合仑伐替尼靶向治疗对晚期肝癌能较好的控制肿瘤进展,可作为超米兰标准肝癌肝移植前有效的桥接治疗手段,近期预后良好,对腹部切口的影响以及患者的中远期疗效需增加样本量并长期随访。

关键词: 肝细胞癌, 肝移植, 靶向药物, 介入治疗, 桥接

Abstract: Objective To explore new plans for liver cancer down-staging or bridging therapy before ultra-Milan standard liver cancer transplantation, and to evaluate the safety and efficacy of Transarterial chemoembolization combined with Lenvatinib in the treatment of ultra-Milan standard liver cancer after liver transplantation. Methods Retrospective analysis was performed on the clinical data of 2 cases of patients with ultra-Milan standard liver cancer successfully bridged by liver transplantation after transarterial chemoembolization for treatment combined with targeted therapy of Lenvatinib in our center. The prognosis of the patients was evaluated by regular reexamination of serological markers, CT examination or liver color ultrasound, so as to evaluate the clinical possibility and usability of the new bridging protocol. Results The first patient for liver cancer with portal venous tumor emboli right branch of, for liver cancer stage (CNLC stage IIIa) in our country, after Transarterial chemoembolization combined with Lenvatinib bridging for 2 months, patients received liver transplantation, postoperative incision healed well, postoperative pathological suggest most tumor necrosis, only a few members of the heterocyst around the cell mass. Regular follow-up of 16 months, no tumor recurrence was observed. The Second patientwith liver cancer associated with liver vein invasion, as CNLC stage IIIa, after Transarterial chemoembolization combined with Lenvatinib bridging for one month, oncology evaluation for SD, patient received allogeneic orthotopic liver transplantation, postoperative incision healing is good. Postoperative pathology showed that most of the tissues were necrotic, and only a few tumor cells were arranged in cord like and adenoid. No recurrence of tumor was found in regular follow-up for 14 months. Both patients had normal liver function and no other complications occurred. Conclusion Transarterial chemoembolization for treatment combination with Lenvatinib can better control tumor progression in advanced liver cancer, and can be used as an effective bridging therapy for ultra-Milan standard liver cancer before liver transplantation. The short-term prognosis is good, and the influence on abdominal incision and the long-term efficacy of patients need to increase the sample size and long-term follow-up.

Key words: hepatocellular carcinoma, liver transplantation, targeted drugs, transarterial chemoembolization for treatment, bridging therapy

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