{
  "abstract": "Background\n\nHepatocellular carcinoma (HCC) has a high incidence worldwide, and most patients are diagnosed at the intermediate or advanced stages; 10%-40% lose the opportunity for surgery due to concomitant vascular invasion. A triple-therapy regimen combining transarterial chemoembolization (TACE)/hepatic arterial infusion chemotherapy (HAIC) with targeted therapy and immunotherapy offers promise for conversion therapy in advanced HCC; however, its efficacy is limited in high-burden patients with concomitant major vascular invasion and extrahepatic metastases, and a quadruple-therapy regimen for conversion therapy remains to be explored.Case summary\n\nThis report describes a 33-year-old male patient with Barcelona Clinic Liver Cancer-C (BCLC-C) stage HCC, accompanied by cancer emboli in the inferior vena cava and portal vein, as well as lung metastases, for whom there were no indications for surgery. Following a Multidisciplinary Team (MDT) discussion, the patient was initially treated with a triple-agent regimen of TACE combined with apatinib and camrelizumab for one cycle (21 days per cycle). The response was limited, and a new tumor thrombus developed in the right hepatic vein; treatment was therefore adjusted to a quadruple-agent regimen of TACE-HAIC combined with apatinib and camrelizumab for three cycles (21 days per cycle). The patient achieved a partial response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST), and alpha-fetoprotein (AFP) levels decreased significantly. The patient subsequently underwent partial hepatectomy combined with inferior vena cava reconstruction, and postoperative pathology confirmed a pathological complete response (pCR). As of June 30, 2026, follow-up has shown no evidence of tumor recurrence, tumor markers are within normal limits, and disease-free survival (DFS) has exceeded 12 months.Conclusion\n\nThis case suggests that, for patients with advanced HCC complicated by major vascular invasion and extrahepatic metastases who are carefully selected by an MDT, a sequential four-drug regimen may lead to successful conversion. These results are based on a single case observation and may serve as a basis for research hypotheses; however, the efficacy and safety of this approach still require validation through prospective studies.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hepatobiliary Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, Gansu Province, 730050, People's Republic of China.",
    "First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, 730030, People's Republic of China.",
    "Department of Medicine, Northwest Minzu University, Lanzhou, Gansu Province, 730050, People's Republic of China."
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Xiongxiong Han"
    },
    {
      "affs": [
        0
      ],
      "name": "Yaoping Pang"
    },
    {
      "affs": [
        0
      ],
      "name": "Shulin Xu"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Liangbin Ma"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yong Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jianwei Qin"
    },
    {
      "affs": [
        0
      ],
      "name": "Long Yan",
      "orcid": "0009-0004-0029-3402"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/241xzh21d1m89.bib",
  "cited_by": 0,
  "doi": "10.2147/jhc.s643390",
  "fulltext_url": "https://europepmc.org/articles/PMC13724043",
  "id": "241xzh21d1m89",
  "issns": [
    "2253-5969"
  ],
  "landing_url": "https://europepmc.org/article/MED/42968800",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2721|Hepatocellular Carcinoma Treatment and Prognosis"
    ]
  ],
  "openalex": "W7224087582",
  "pdf_url": "https://europepmc.org/articles/PMC13724043?pdf=render",
  "pmcid": "PMC13724043",
  "pmid": "42968800",
  "published": "2026-10-28",
  "publisher": "Dove Press",
  "ris": "https://research.draconitic.com/paper/241xzh21d1m89.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:53Z",
      "native_id": "MED:42968800",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42968800"
    },
    {
      "first_seen": "2026-11-04T12:22:34Z",
      "native_id": "PMC13724043",
      "source": "pmc",
      "url": "https://doi.org/10.2147/jhc.s643390"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis",
      "subfield": "general"
    }
  ],
  "title": "A Case of Advanced Hepatocellular Carcinoma with Macrovascular Invasion and Lung Metastases Achieving Pathological Complete Remission Following Sequential Multimodal Therapy: A Case Report.",
  "title_text": "A Case of Advanced Hepatocellular Carcinoma with Macrovascular Invasion and Lung Metastases Achieving Pathological Complete Remission Following Sequential Multimodal Therapy: A Case Report.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:45Z",
  "url": "https://research.draconitic.com/paper/241xzh21d1m89",
  "venue": "Journal of hepatocellular carcinoma",
  "versions": []
}