初始不可切除肝癌转化治疗后行肝切除术九例临床特征分析  

Clinical characteristics of originally unresectable hepatocellular carcinoma treated first with conversion therapy and then with hepatectomy:An analysis of 9 patients

作　　者：韩福洲 钱红纲[2] 胡越 赵炳善 曲军[1] 王德仲[1] HAN Fu-zhou;QIAN Hong-gang;HU Yue;ZHAO Bing-shan;QU Jun;WANG De-zhong(Department of General Surgery,Aerospace Center Hospital,Beijing 100049,China;Yuhe Cancer Center,Peking University Cancer Hospital,Beijing 100039,China)

机构地区：[1]航天中心医院普外科,北京100049 [2]北京大学肿瘤医院裕和肿瘤中心,北京100039

出　　处：《肝胆胰外科杂志》2021年第12期715-720,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的分析初始不可切除的肝癌转化治疗后再行肝切除术的临床特征,为初始不可切除肝癌的治疗提供依据。方法回顾性分析航天中心医院普外科和北京大学肿瘤医院裕和肿瘤中心2019年1月至2021年4月间收治的9例初始不可切除的肝癌患者临床资料。结果9例患者均为男性,中位年龄48(33~61)岁;均合并乙肝肝硬化,肝功能Child-Pugh A级4例,B级5例;巴塞罗那分期B期4例,C期5例;PS评分均≤1分。转化治疗方案:6例行帕博利珠单抗联合仑伐替尼治疗,1例行卡瑞利珠单抗联合仑伐替尼治疗,1例行卡瑞利珠单抗联合阿帕替尼治疗,1例行信迪利单抗联合仑伐替尼治疗。治疗过程中发生高血压5例、乏力6例、腹泻2例。转化治疗后再行肝切除术:行左半肝切除术5例,右半肝切除术3例,左半肝联合尾状叶切除术1例,均为R0切除。1例患者因腹腔出血再次手术,其余患者无明显手术相关并发症发生。术后住院时间(12.9±2.1)d;术后中位随访时间10.1个月,随访期间肝癌复发2例,其余7例患者生存状态良好,随访期间无死亡病例出现。结论免疫治疗联合靶向治疗在初始不可切除的肝癌转化治疗中有效且安全。Objective To analyze the clinical characteristics of originally unresectable hepatocellular carcinoma who treated first with conversion therapy and then with hepatectomy,to provide the basis for the treatment of initial unresectable hepatocellular carcinoma.Methods The clinical data of 9 originally unresectable hepatocellular carcinoma patients admitted in Aerospace Center Hospital and Yuhe Cancer Center of Peking University Cancer Hospital between Jan.2019 and Apr.2021 were analyzed retrospectively.Results All 9 patients were male with a median age of 48(33-61)years.There were 4 cases with Child-Pugh grade A and 5 cases with grade B;4 cases with BCLC stage B and 5 cases with stage C;PS scores were all≤1.Conversion therapy programme:6 patients received Pembrolizuma combined with Lenvatinib,1 patient received Camrelizumab combined with Lenvatinib,1 patient received Camrelizumab combined with Apatinib,and 1 patient received Sintilimab combined with Lenvatinib.During the treatment,hypertension was found in 5 patients,fatigue in 6 patients,diarrhea in 2 patients.Hepatectomy was then implemented after conversion therapy:5 patients received left hepatectomy,3 patients received right hepatectomy,and 1 patient received left hemihepatectomy combined with caudate lobectomy.All patients underwent R0 resection.Only 1 patient underwent reoperation due to abdominal hemorrhage,and the other 8 patients had no operation-related complications.The time of postoperative hospitalization was(12.9±2.1)d.During the median follow-up of 10.1 months,tumor recurrence occurred in 2 patients,and the other 7 patients were in good condition,no death occurred.Conclusion Conversion therapy of immune therapy combined with targeted therapy is effective and safe for originally unresectable hepatocellular carcinoma.

关 键 词：肝癌 初始不可切除 免疫治疗 靶向治疗 转化治疗 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]