A Case of Advanced Hepatocellular Carcinoma with Macrovascular Invasion and Lung Metastases Achieving Pathological Complete Remission Following Sequential Multimodal Therapy: A Case Report.
- 1Department 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.
- 2First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, 730030, People's Republic of China.
- 3Department of Medicine, Northwest Minzu University, Lanzhou, Gansu Province, 730050, People's Republic of China.
Abstract
Background
Hepatocellular 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
This 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
This 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.
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BibTeX
@article{han2026case,
title = {{A Case of Advanced Hepatocellular Carcinoma with Macrovascular Invasion and Lung Metastases Achieving Pathological Complete Remission Following Sequential Multimodal Therapy: A Case Report.}},
author = {Xiongxiong Han and Yaoping Pang and Shulin Xu and Liangbin Ma and Yong Wang and Jianwei Qin and Long Yan},
journal = {Journal of hepatocellular carcinoma},
year = {2026},
month = oct,
doi = {10.2147/jhc.s643390},
url = {https://europepmc.org/article/MED/42968800},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - A Case of Advanced Hepatocellular Carcinoma with Macrovascular Invasion and Lung Metastases Achieving Pathological Complete Remission Following Sequential Multimodal Therapy: A Case Report.
AU - Xiongxiong Han
AU - Yaoping Pang
AU - Shulin Xu
AU - Liangbin Ma
AU - Yong Wang
AU - Jianwei Qin
AU - Long Yan
PY - 2026
DA - 2026/10/28
JO - Journal of hepatocellular carcinoma
DO - 10.2147/jhc.s643390
UR - https://europepmc.org/article/MED/42968800
AB - Background Hepatocellular 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 This 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 This 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.
SN - 2253-5969
ER -