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case_images: (A) The huge lump on the right lobe of the liver was surgically removed in April 2017. (B) The postoperative follow-up (May 2018) showed tumor recurrence in the lungs. (C) At the end of the last arsenic trioxide chemotherapy and before the use of tislelizumab (October 2018). (D) The efficacy was first evaluated as a partial response after 2 cycles of treatment with tislelizumab (January 2019). (E) The efficacy was first evaluated as a complete response after 12 cycles of treatment with tislelizumab (July 2019). (F) The patient still had a complete response at the latest follow-up (July 2023). The red arrow in Figure 1A indicates the location of the primary tumor. Arrows in Figure 1B, 1C and 1D indicate the location of recurrent tumors in the lungs.
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case_images: The initial Computed Tomography (CT) scan on April 2017, revealed hepatic masses, liver cirrhosis, and splenomegaly (Figure 1A). Regular examinations were conducted until May 2018, when an increased level of AFP (76.60 IU/mL) and chest CT results indicated tumor recurrence and the presence of five bilateral lung metastatic lesions, with the largest lesion measuring approximately 2.5 cm (Figure 1B), and other metastatic lesions were shown in Figure S1A Subsequently, the patient received four cycles of systemic chemotherapy using FOLFOX regimen (oxaliplatin 150 mg, D1; 5-FU 0.7g, D1-5; calcium folinate 300 mg, D1-5) triweekly from May to July 2018. However, re-examination in October 2018 revealed further growth of lung lesions and the appearance of new lesions, with the largest measuring 5.4x3.2 cm (Figure 1C), and other lung lesions were shown in Figure S1B. TBIL was 19.2 micromol/L. After two cycles of therapy, the CT images showed a partial response (PR) in the pulmonary lesions (Figures 1D and S1C). Three cycles later, the AFP level normalized, and the level of TBIL was 19.3 micromol/L. In July 2019, after 12 cycles of treatment, the patient achieved a CR (Figures 1E and S1D), with a neutrophil to lymphocyte ratio (NLR) of 2.83 (Figure 2A) and In the latest re-examination conducted in July 2023, the patient remained in a continuous CR state (Figure 1F) and achieved an overall survival (OS) exceeding 6 years.
case_images: Evolution in time of the albumin-bilirubin (ALBI) score and neutrophil-to-lymphocyte ratio (NLR) (A), alpha-fetoprotein (AFP) levels (B), aspartate aminotransferase (AST), creatinine (CR), and alanine aminotransferase (ALT) (C), direct bilirubin (DBIL), indirect bilirubin (IDBIL), and total bilirubin (TBIL) (D).
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case_images: The AFP level continued to rise to 667.4 IU/mL (Figure 2B), accompanied by an increased level of total bilirubin (TBIL) of 14.2 micromol/L. In addition, the patient's albumin-bilirubin (ALBI) score was 1-2 throughout the anti-tumor treatment (Figure 2A), and his hepatitis B status was under control with regular antiviral therapy. During the patient's treatment with tislelizumab, the average level of TBIL increased to 30.50 micromol/L from the average level of 22.99 micromol/L observed at relapse prior to tislelizumab therapy (Figure 2D). The levels of alanine aminotransferase (ALT), aspartic transaminase (AST), and bilirubin showed a mild to moderate increase after the first cycle of immunotherapy (Figure 2C), but quickly recovered with the administration of glutathione. The highest peak of TBIL level was observed approximately two years later in June 2020, reaching 62.17 micromol/L.
case_images: The timeline of patients treated.
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case_images: The timeline is shown in Figure 3. 