不可切除肝细胞癌(CNLC-IIIb期肺转移)行转化治疗后成功切除一例并文献复习
Unresectable Hepatocellular Carcinoma (CNLC-IIIb Lung Metastasis) Was Successfully Resected after Conversion Therapy, and Literature Review

病史摘要：患者，59岁中年男性，因“上腹部胀痛2月”于2021年4月6日入院，既往史：无。症状体征：上腹部胀痛2月，余未见异常。实验室检查：乙肝病史，AFP升高，上腹部CT结果显示肝右叶及肝左叶内侧段占位性病变，考虑巨块型肝癌。治疗经过：患者行介入栓塞治疗后，行替雷丽珠单抗于仑伐替尼4个周期，复查发现肿瘤体积缩小，双肺转移灶无明显进展后，行肝脏部分切除。患者转归：患者术后进行规律复查，身体各项机能良好，未见肿瘤复发迹象。原发性肝癌发病率居全球常见癌症第6位，癌症相关死因居第4位，是一种易复发、恶性程度高的疾病。其中肝细胞癌(Hepatocellular Carcinoma, HCC)占绝大多数，且多数患者初次就诊时病情已处于中晚期，预后相对较差，尤其是无法一期手术切除的BCLC-C/CNLC-IIIb期肝癌为著。肝细胞癌(HCC)是主要的原发性肝癌类型。目前肝细胞癌的治疗方法主要包括肝切除术、肿瘤消融术、动脉内治疗、肝移植和免疫检查点抑制剂治疗。然而，由于缺乏早期HCC的典型症状，大多数患者已经处于初次就诊的中/晚期，因此错过了最佳治疗时机。尽管HCC有多种治疗方法，但肝细胞癌(HCC)的预后仍然不利，5年生存率为18%。我们报道了一例双肺转移的CNLC-IIIb期肝癌患者诊疗过程，旨在提示程序性死亡蛋白-1 (PD-1)抗体联合酪氨酸激酶抑制剂(Tyrosine Kinase Inhibitors, TKIs)加局部治疗转化后序贯外科手术方案对于同时具有远处转移的肝癌患者也可取得生存获益。
Summary of medical history: The patient, a 59-year-old middle-aged male, was admitted to the hos-pital on April 6, 2021 due to “epigastric distension pain for 2 months”, past medical history: none. Symptoms and signs: Epigastric distension and pain for 2 months, and no abnormalities were seen in the remainder. Laboratory tests: History of hepatitis B, elevated AFP, and mass lesions in the right lobe and medial segment of the left lobe of the liver on CT scan of the upper abdomen were considered. Treatment: After interventional embolization, the patient was treated with tilelizumab and lenvatinib for 4 cycles, and the tumor volume was reduced and the metastases in both lungs did not progress, and the liver was partially resected. Patient outcomes: The patient underwent regular follow-up examinations after surgery, and all physical functions were good, and there was no sign of tumor recurrence. Primary liver cancer is the sixth most common cancer in the world and the fourth leading cause of cancer-related deaths. Hepatocellular carcinoma (HCC) accounts for the vast majority of patients, and most patients are in the middle and advanced stages of the disease at the time of initial presentation, and the prognosis is relatively poor, especially for BCLC-C/CNLC-III. Stage b liver cancer cannot be resected by primary surgery. Hepatocellular carcinoma (HCC) is the predominant type of primary liver cancer. Current treatments for hepatocellular carcinoma include liver resection, tumor ablation, intra-arterial therapy, liver transplantation, and immune check-point inhibitor therapy. However, due to the lack of typical symptoms of early HCC, most patients are already in the intermediate/advanced stages of their initial presentation and thus miss the op-timal timing of treatment. Although there are multiple treatments for HCC, the prognosis for hepa-tocellular carcinoma (HCC) remains unfavorable, with a 5-year