A Case of Conversion Hepatectomy for Hepatocellular Carcinoma with Vascular Invasion after Atezolizumab-bevacizumab Treatment

抄録

We report a hepatocellular carcinoma (HCC) case with vascular invasion successfully treated by conversion hepatectomy after treatment by atezolizumab-bevacizumab. A 74-year-old male patient was diagnosed with HCC and referred to our hospital. The tumor at the anterior section was 12.3 cm in diameter. It had invaded a portal vein branch of subsection 5 (S5) and peripheral branches of the middle hepatic vein. Serum alpha-fetoprotein (AFP) level was extremely high at 177408.3 ng/ml. The patient first received atezolizumab-bevacizumab treatment. After three cycles of atezolizumab-bevacizumab therapy, the tumor had decreased in size, the invasion into a portal and hepatic vein disappeared, the tumor enhancement completely vanished in the CT scan, and the tumor markers became within normal range. We decided to perform a conversion hepatectomy. The tumor was removed entirely by S5 partial resection, and pathological analyses showed a complete response to atezolizumab-bevacizumab treatment. There was no perioperative complication. The patient has survived for nine months without recurrence so far. Atezolizumab combined with bevacizumab might be an effective and appropriate option for the multidisciplinary treatment aiming for curative surgical resection.