PDF(Pubmed)
Abstract：
BACKGROUND: Transarterial chemoembolization (TACE) is widely performed for intermediate-stage or unresectable hepatocellular carcinoma (HCC), but approximately half of patients do not respond to TACE treatment. We describe a case of rapidly progressing of HCC after TACE and provide a possible hypothesis for this condition. The finding may contribute to identifying patients who obtain less benefit from TACE, thus avoiding the unnecessary waste of medical resources and treatment during the golden hour window.
METHODS: A 61-year-old woman had been diagnosed with chronic hepatitis B infection and HCC at Barcelona Clinic Liver Cancer stage B, which had been treated by segmental hepatectomy 14 mo ago. The tumor recurred in the two months after surgery. She received an initial TACE and then underwent systemic therapy with lenvatinib 8 mg daily due to an increased level of alpha-fetoprotein (AFP) after the first TACE. However, the tumor continued to progress with an increased level of AFP, and she underwent a second TACE, after which the tumor volume did not obviously decrease on the contrast-enhanced computed tomography image. One month later, she had a third TACE to control the residual HCC tumors. Two weeks after that, the HCC had increased dramatically with tea-colored urine and yellowish skin turgor. Eventually, the patient refused further treatment and went into hospice care.
CONCLUSIONS: Intense hypoxia induced by TACE can trigger rapid disease progression in infiltrative HCC patients with a large tumor burden.
METHODS: A 61-year-old woman had been diagnosed with chronic hepatitis B infection and HCC at Barcelona Clinic Liver Cancer stage B, which had been treated by segmental hepatectomy 14 mo ago. The tumor recurred in the two months after surgery. She received an initial TACE and then underwent systemic therapy with lenvatinib 8 mg daily due to an increased level of alpha-fetoprotein (AFP) after the first TACE. However, the tumor continued to progress with an increased level of AFP, and she underwent a second TACE, after which the tumor volume did not obviously decrease on the contrast-enhanced computed tomography image. One month later, she had a third TACE to control the residual HCC tumors. Two weeks after that, the HCC had increased dramatically with tea-colored urine and yellowish skin turgor. Eventually, the patient refused further treatment and went into hospice care.
CONCLUSIONS: Intense hypoxia induced by TACE can trigger rapid disease progression in infiltrative HCC patients with a large tumor burden.
摘要：
背景：经动脉化疗栓塞（TACE）广泛用于中期或不可切除的肝细胞癌（HCC），但是大约一半的患者对TACE治疗没有反应。我们描述了TACE后HCC快速进展的情况，并为这种情况提供了可能的假设。这一发现可能有助于识别从TACE中获益较少的患者。从而避免了在黄金时间窗口期间不必要的医疗资源和治疗浪费。
方法：一名61岁的妇女在巴塞罗那诊所肝癌B期被诊断出患有慢性乙型肝炎感染和HCC，14个月前进行了肝切除术。术后2个月肿瘤复发。她接受了初始TACE，然后接受了lenvatinib的全身治疗，每天8mg，这是由于第一次TACE后甲胎蛋白（AFP）水平升高。然而,随着AFP水平的升高，肿瘤继续进展，她接受了第二次治疗，之后，在对比增强的计算机断层扫描图像上，肿瘤体积没有明显减小。一个月后,她进行了第三次TACE以控制残留的HCC肿瘤.两周后,随着茶色尿液和淡黄色皮肤充盈，HCC急剧增加。最终,患者拒绝进一步治疗，接受临终关怀。
结论：TACE诱导的强烈缺氧可引发肿瘤负荷较大的浸润性HCC患者的快速疾病进展。
方法：一名61岁的妇女在巴塞罗那诊所肝癌B期被诊断出患有慢性乙型肝炎感染和HCC，14个月前进行了肝切除术。术后2个月肿瘤复发。她接受了初始TACE，然后接受了lenvatinib的全身治疗，每天8mg，这是由于第一次TACE后甲胎蛋白（AFP）水平升高。然而,随着AFP水平的升高，肿瘤继续进展，她接受了第二次治疗，之后，在对比增强的计算机断层扫描图像上，肿瘤体积没有明显减小。一个月后,她进行了第三次TACE以控制残留的HCC肿瘤.两周后,随着茶色尿液和淡黄色皮肤充盈，HCC急剧增加。最终,患者拒绝进一步治疗，接受临终关怀。
结论：TACE诱导的强烈缺氧可引发肿瘤负荷较大的浸润性HCC患者的快速疾病进展。
