Objective To summarize the comprehensive multidisciplinary team (MDT) treatment and holistic scientific management approach in a case of hepatocellular carcinoma (HCC) in S7+S9 segments with prostatic metastasis. Methods A retrospective analysis was conducted on the clinical data and follow-up outcomes of a patient with HCC in S7+S9 segments who developed prostatic metastasis during treatment, admitted to the Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province). Results Due to the complexity of the patient’s condition, an MDT discussion was held upon initial admission. It was concluded that the HCC diagnosis was clear, with lesions confined to the liver (S7+S9 segments) and a tumor diameter less than 3 cm, making surgical resection or ablation therapy the preferred options. However, the patient declined liver transplantation and surgical resection. Therefore, CT-guided microwave ablation (MWA) was performed on the primary HCC lesions in segments S7 and S9b. Prior to subsequent treatments for recurrent disease, MDT discussions were held again, and treatments were tailored to the discussion outcomes while respecting the patient’s wishes. Over time, the patient underwent CT-guided liver puncture MWA, re-ablation for recurrent tumors, transarterial chemoembolization (TACE), stereotactic body radiation therapy (SBRT), targeted therapy, and immunotherapy. Following this comprehensive MDT treatment plan, the patient had survived for over 78 months, with no evidence of active tumor lesions in the liver, prostate, or other parts of the body. Alpha-fetoprotein levels and liver function remained normal, and the patient’s quality of life was good. Conclusion Comprehensive MDT treatment incorporates various technologies and approaches, along with holistic scientific management, can yield favorable outcomes for patients with complex and challenging HCC.
Citation：
CHEN Yunhao, LI Haoquan, WANG Zaiguo, ZHANG Weibiao, ZHANG Xuefang, ZHANG Zhicheng, LIAO Jingsheng, MO Yanxia, YE Zhenwei, JIANG Jingzhu. Experience in comprehensive treatment of a case of difficult and complex hepatocellular carcinoma under the MDT mode. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(9): 1063-1069. doi: 10.7507/1007-9424.202403088
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中国抗癌协会肝癌专业委员会. 中国肝癌多学科综合治疗专家共识. 中国医学前沿杂志(电子版), 2020, 12(12): 28-36.
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四川大学华西医院肝癌MDT团队. 肝细胞肝癌全程多学科规范化管理: 华西医院多学科专家共识(第二版). 中国普外基础与临床杂志, 2020, 27(9): 1062-1077.
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刘允怡, 迟天毅. 肝脏S9段. 中华外科杂志, 2002, 40(5): 25-26.
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刘允怡. 肝切除与肝移植应用解剖学. 北京: 人民卫生出版社, 2016: 20-25.
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张伟标, 黄彦, 王在国, 等. 肝脏S9段的应用解剖及精准微创消融. 中国普外基础与临床杂志, 2023, 30(8): 905-910.
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陈延宇, 张晓赟, 李川, 等. 复发性肝细胞癌的外科治疗现状与进展. 华西医学, 2019, 34(6): 688-692.
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Sugawara Y, Hibi T. Surgical treatment of hepatocellular carcinoma. Biosci Trends, 2021, 15(3): 138-141.
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张煌斌, 鄢业鸿, 万昊, 等. 原发性肝癌前列腺转移1例报告. 临床肝胆病杂志, 2021, 37(6): 1427-1428.
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Liu K, Hao M, Ouyang Y, et al. CD133+ cancer stem cells promoted by VEGF accelerate the recurrence of hepatocellular carcinoma. Sci Rep, 2017, 7: 41499. doi: 10.1038/srep41499.
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Park DJ, Sung PS, Lee GW, et al. Preferential expression of programmed death ligand 1 protein in tumor-associated macrophages and its potential role in immunotherapy for hepatocellular carcinoma. Int J Mol Sci, 2021, 22(9): 4710. doi: 10.3390/ijms22094710.
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- 1. 中国抗癌协会肝癌专业委员会. 中国肝癌多学科综合治疗专家共识. 中国医学前沿杂志(电子版), 2020, 12(12): 28-36.
- 2. Naugler WE, Alsina AE, Frenette CT, et al. Building the multidisciplinary team for management of patients with hepatocellular carcinoma. Clin Gastroenterol Hepatol, 2015, 13(5): 827-835.
- 3. 中华人民共和国国家卫生和计划生育委员会. 原发性肝癌诊疗规范 (2017年版). 临床肝胆病杂志, 2017, 33(8): 1419-1431.
- 4. 四川大学华西医院肝癌MDT团队. 肝细胞肝癌全程多学科规范化管理: 华西医院多学科专家共识(第二版). 中国普外基础与临床杂志, 2020, 27(9): 1062-1077.
- 5. 中华医学会超声医学分会, 中国研究型医院学会肿瘤介入专业委员会. 影像引导原发性肝癌消融指南(2023版). 中华肝脏病杂志, 2024, 32(2): 97-112.
- 6. 刘允怡, 迟天毅. 肝脏S9段. 中华外科杂志, 2002, 40(5): 25-26.
- 7. 刘允怡. 肝切除与肝移植应用解剖学. 北京: 人民卫生出版社, 2016: 20-25.
- 8. 张伟标, 黄彦, 王在国, 等. 肝脏S9段的应用解剖及精准微创消融. 中国普外基础与临床杂志, 2023, 30(8): 905-910.
- 9. 王在国, 张伟标, 叶振伟, 等. CT引导下经皮肝穿刺微波消融治疗Ⅸ段原发性肝癌的临床研究. 中华肝胆外科杂志, 2020, 26(11): 825-828.
- 10. 陈延宇, 张晓赟, 李川, 等. 复发性肝细胞癌的外科治疗现状与进展. 华西医学, 2019, 34(6): 688-692.
- 11. 丁福全, 王在国. 肝癌复发转移的临床研究进展. 中国实用外科杂志, 2000, 20(3): 46-47.
- 12. Sugawara Y, Hibi T. Surgical treatment of hepatocellular carcinoma. Biosci Trends, 2021, 15(3): 138-141.
- 13. 张煌斌, 鄢业鸿, 万昊, 等. 原发性肝癌前列腺转移1例报告. 临床肝胆病杂志, 2021, 37(6): 1427-1428.
- 14. 曾效力, 樊长姝. 前列腺转移癌一例. 实用医学影像杂志, 2003, 4(6): 358.
- 15. Liu K, Hao M, Ouyang Y, et al. CD133+ cancer stem cells promoted by VEGF accelerate the recurrence of hepatocellular carcinoma. Sci Rep, 2017, 7: 41499. doi: 10.1038/srep41499.
- 16. Park DJ, Sung PS, Lee GW, et al. Preferential expression of programmed death ligand 1 protein in tumor-associated macrophages and its potential role in immunotherapy for hepatocellular carcinoma. Int J Mol Sci, 2021, 22(9): 4710. doi: 10.3390/ijms22094710.
