Primary liver cancer (hereinafter referred to as liver cancer) is the fourth most common cancer and second leading cause of cancer-related deaths of China. Hepatocellular carcinoma (HCC) accounts for 75% to 85% of liver cancers, more than half of patients with HCC present at an advanced stage where surgery is not suitable. Conversion therapy can provide the opportunity for some unresectable patients to realize surgical resection. With the progress of non-surgical treatments for liver cancer, increased emphasis on comprehensive treatment approaches, and continuous clinical research outcome, conversion therapy of liver cancer has become a common clinical pathway in treatment practice in our country. This paper summarizes the progress in research on conversion therapy for HCC, analyzing its methods, efficacy, safety, and timing of surgery, to provide insights for the clinical practice and research of conversion treatment in HCC.
With the publication of a vast amount of clinical research on hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases (AASLD), the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the National Health Commission of China have all updated their diagnostic and treatment guidelines for HCC. There are no differences in the definition of HCC risk populations among the AASLD 2023, NCCN 2024, and China Liver Cancer Staging and Treatment Guideline (CNLC) 2024. Notably, CNLC 2024 has updated its guidance on high-risk factors and prospective surveillance for HCC based on the characteristics of HCC patients in China. The four guidelines have seen significant updates in the areas of neoadjuvant and adjuvant therapies, local treatments, and systemic treatments for HCC. CNLC 2024 refines the indications for local treatment, improves systemic treatment, and introduces new first-line therapy, including camrelizumab combined with rivoceranib or tislelizumab. The second-line therapy nivolumab plus ipilimumab for advanced HCC are recommended by AASLD 2023, NCCN 2024, and ASCO 2024, which may become a new first-line therapeutic option for patients with advanced HCC. We compare and interpret these four guidelines in this paper.
ObjectiveTo explore the safety and feasibility of surgical treatment of simultaneous multiple primary cancer–hepatocellular carcinoma and esophageal squamous cell carcinoma.MethodThe clinical data of one patient with simultaneous multiple primary cancer of hepatocellular carcinoma and esophageal squamous cell carcinoma, who treated in the First Affiliated Hospital of Guangxi Medical University in April 2019 was analyzed retrospectively. ResultsThe patient was diagnosed as hepatocellular carcinoma and esophageal squamous cell carcinoma on admission. After MDT in the hospital, the patient underwent anterior right hepatectomy + cholecystectomy and radical resection of esophageal carcinoma in turn. The procedure of anterior right hepatectomy + cholecystectomy was smooth, the duration of the surgery was 270 min, and the total blood loss was 500 mL, and postoperative pathology showed that hepatocellular carcinoma was in grade Ⅱ. The operation process of radical resection of esophageal cancer was smooth too, the duration of the surgery was 176 min, and the total blood loss was 100 mL, and postoperative pathology showed moderately differentiated squamous cell carcinoma. No related surgical complications occurred after the operation. Thirteen months after the operation of liver cancer and 10 months after the operation of esophageal cancer, the patient was generally in good condition, well wound healing, and no clinical recurrence. The follow-up of the patient was continued.ConclusionIn allusion to simultaneous multiple primary cancers, it is safe and feasible to evaluate the location, pathological stage, and general condition of the patient by combining multi-disciplinary diagnosis and treatment and then performing radical operations in turn.