巨块型肝癌TACE联合阿帕替尼靶向治疗带瘤长期生存个案报道

Giant Massive Hepatocellular Carcinoma with Long-Term Tumor-Bearing Survival after TACE Combined with Apatinib Targeted Therapy: A Case Report

摘要: 本研究报道1例67岁男性巨块型肝细胞癌患者(肿瘤直径13.6 × 10.8 × 13.9 cm，BCLC A期)，通过经导管动脉化疗栓塞术(Transcatheter Arterial Chemoembolization, TACE)联合甲磺酸阿帕替尼及替吉奥化疗的综合方案实现长期生存的临床过程。患者首次TACE后肿瘤体积缩小至11.1 × 8.7 × 9.4 cm，甲胎蛋白(AFP)从1588.26 ng/mL降至46.71 ng/mL；因索拉非尼过敏调整方案后，持续使用阿帕替尼(500 mg/d)联合替吉奥，3个月后AFP进一步降至9.8 ng/mL，影像学评估显示肿瘤持续退缩且无进展。随访7年期间，肿瘤最大层面缩小至8.4 × 5.4 × 6.2 cm，肝功能维持Child-Pugh A级，未见复发或转移。本病例提示，TACE联合阿帕替尼及化疗药物可通过局部栓塞、抗血管生成与全身治疗的协同作用在该患者中观察到长期的疾病稳定，个体化方案调整与不良反应管理是治疗成功的关键，为类似病例提供了临床参考。

Abstract: This study reports a 67-year-old male patient with giant massive hepatocellular carcinoma (tumor diameter 13.6 × 10.8 × 13.9 cm, Barcelona Clinic Liver Cancer [BCLC] stage A) who achieved long-term survival through a comprehensive regimen of transcatheter arterial chemoembolization (TACE) combined with apatinib mesylate and tegafur/gimeracil/oteracil (S-1) chemotherapy. After the first TACE, tumor volume reduced to 11.1 × 8.7 × 9.4 cm, and alpha-fetoprotein (AFP) levels decreased from 1588.26 ng/mL to 46.71 ng/mL. Following treatment adjustment for sorafenib allergy, continuous apatinib (500 mg/d) plus S-1 therapy further reduced AFP to 9.8 ng/mL within 3 months, with imaging confirming sustained tumor regression and no progression. During 7 years of follow-up, the tumor shrank to 8.4 × 5.4 × 6.2 cm, liver function remained Child-Pugh class A, and no recurrence or metastasis was observed. This case suggests that TACE combined with apatinib and chemotherapeutic agents can achieve long-term disease stability in this patient through the synergistic effects of local embolization, anti-angiogenesis, and systemic therapy. Individualized treatment regimen adjustments and adverse reaction management are the keys to successful treatment, which provides clinical reference for similar cases.