Efficacy of sequential surgical resection for initial unresectable hepatocellular carcinoma after interventional therapy plus targeted immunotherapy
Objective To evaluate the clinical efficacy of sequential surgical resection for initial unresectable hepatocellular carcinoma(HCC)after interventional therapy plus targeted immunotherapy.Methods From June 2021 to April 2023,retrospective review was performed for the relevant clinical data from 10 patients of initial unresectable HCC.Results There were 8 males and 2 females with a median age of 55(33-72)years.Child Pugh grade was A(n=6)and B(n=4).And China Liver Cancer(CNLC)stage was Ⅱb(n=4)and Ⅲa(n=6).Portal vein cancer thrombus was present(n=6)or absent(n=4).Maximal tumor diameter prior to transformation therapy was 13 cm.The pre-treatment level of alpha feto-protein(AFP)was>400 μg/L(n=7)and<400 μg/L(n=3).Conversion treatment protocol was transcatheter arterial chemoembolization(TACE)plus targeted immunotherapy(n=6)and hepatic artery infusion chemotherapy(HAIC)plus targeted immunotherapy(n=4).There were hypertension(n=4),fatigue(n=2)and diarrhea(n=1)during treatment.Median conversion time was 4 months.Median preoperative level of AFP after conversion therapy was 7.2 μg/L and maximal preoperative diameter of tumor after conversion therapy 8.8 cm.Preoperative imaging assessment of outcomes was complete remission(CR,n=4),partial remission(PR,n=3)and stable disease(SD,n= 3).After therapy,the procedures included partial hepatectomy(n=3),semi-hepatic resection(n=7),laparoscopy(n=7)and open surgery(n=3).Median surgical time was 240 min,median intraoperative volume of blood loss 400 mL,median postoperative hospital stay 8 days and median postoperative drainage tube removal time 7 days.Postoperative pathological results were pCR(n=3)and pPR(n=7).MVI grade was M0(n=8)and M1(n=2).There was no positive case of resection margin.There were postoperative ascites(n=1)and bile leakage(n=1).No obvious postoperative complications occurred.During a median postoperative follow-up period of 8 months,one case recurred and there was no death.Conclusion For initial unresectable HCC,sequential surgical resection along with interventional therapy plus targeted immunotherapy is both effective and safe.
万方数据
维普
