https://orcid.org/0000-0002-1724-1463
Abstract
Hepatocellular carcinoma (HCC) recurrence, which encompasses both true recurrence resulting from cancer spread and de novo tumors developing within the same cancer-prone liver, presents a complication in approximately 70% of cases within a 5-year timeframe. The efficacy of neoadjuvant therapy for recurrence after hepatectomy for hepatocellular carcinoma is still unclear. We report a case of recurrent massive advanced hepatocellular carcinoma with pathological complete remission was treated by continuous hepatic arterial infusion chemotherapy (HAIC) and sequential transcatheter arterial embolization (TAE) combined with secondary operation. One month after resection, the patient recurred (massive type 141mm×76mm). After 4 times of HAIC sequential TAE conversion therapy, the tumor shrank significantly (70mm×29mm), alpha-fetoprotein(AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) levels decreased significantly, residual liver volume[left half liver accounted for 39.85% of standard liver volume(left half liver + right anterior lobe) accounted for 80.17% of standard liver volume] and Indocyanine green 15-minute retention(ICG R15 8.0%) complies with surgical requirement.The second operation was performed, and the tumor was completely resected after hepatic blood flow occlusion Requirement. The postoperative pathological results showed complete remission (PCR) of the tumor, and no recurrence was found during the follow-up of 16 months. In this case, HAIC sequential TAE conversion therapy has good short-term effect on patients with postoperative recurrence of hepatocellular carcinoma, tumor burden is significantly reduced, the second surgery pathology achieves complete remission, safety and tolerance, it is worthy of study and promotion.
Abbreviations
HAIC, hepatic arterial infusion chemotherapy; TAE, transcatheter arterial embolization; AFP, alpha-fetoprotein; PIVKA-II, protein induced by vitamin K absence or antagonist-II; PCR, pathological complete remission; HCC, Hepatocellular carcinoma; HBV, hepatitis B virus; AFB1, aflatoxin B1; CT, computed tomography; FOLFOX, fluorouracil combined with folic acid and oxaliplatin; OS, overall survival; Ag, silver; PAS, Periodic Acid-Schiff.
Ethics Approval and Consent to Participate
This study involving patient was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. The patient provided his written informed consent to participate in this study.
Consent for Publication
Written informed consent was obtained from the patient to publish this case report.
Acknowledgments
The authors would like to thank Professor Xinping Ye and Professor Minhao Peng, Department of Hepatobiliary Surgery, Guangxi Medical University, for their contributions in interpreting the significance of the results of this study.
Author Contributions
All authors made a significant contribution to the work reported, whether that taking part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare that they have no conflicts of interest in this work.