PMC9471014_01
Changes in imaging and serum AFP level during clinical treatment. (A) Preoperative abdominal-enhanced CT revealed a mass in the right posterior lobe of the liver. (B) Preoperative CT showed tumor thrombus in the portal vein. (C) Postoperative abdominal-enhanced CT showed no obvious cancer foci. (D) MRI showed an enlarged nodule in segment II of the liver. (E) Enhanced CT showed no obvious recurrence of cancer. (F) MRI showed enlarged liver lesions in segment V. (G) Enhanced CT showed a CR to regorafenib and camrelizumab. (H) The latest enhanced CT showed no signs of recurrence. (I) AFP level changes during postoperative interventional treatment. (J) AFP level changes during camrelizumab combined with sorafenib or regorafenib. (K) Timeline of treatment process.
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Abdominal B-ultrasound, enhanced computed tomography (CT), and magnetic resonance imaging (MRI) were performed and the patient was diagnosed with primary HCC with PVTT, cirrhosis and chronic viral hepatitis ( Figures 1A, B ). The patient's AFP was rechecked one month after surgery and the result was 49 mug/L, and no obvious cancer foci were seen on enhanced CT examination ( Figure 1C ). The patient underwent MRI on November 27, 2018, and the result showed an enlarged nodule in segment II of the liver, which was considered malignant ( Figure 1D ). Enhanced CT showed no obvious recurrence of cancer, but AFP results were abnormally increased ( Figures 1E, I ). AFP level after the combination of camrelizumab and TKIs were shown in the  Figure 1J , showing AFP decreased to normal from June 2020 and then stabilized. The treatment was discontinued after a comprehensive evaluation in October 13, 2020 ( Figures 1G, K ). After that, only antiviral therapy was given with regular follow-up. The patient underwent enhanced CT examination on March 11, 2022, and no signs of tumor recurrence were found ( Figure 1H ).
The patient's immune cell test results and distribution in the total HCC population test data. (A) The test results of immune cells constituting tumor immune microenvironment. (B) The expression levels of all markers in tissue slides. Merge 1: PD-1 (green), PD-L1 (yellow), CD8 (pink), CD68 (cyan), CD163 (red). Merge 2: CD3(pink), CD4 (red), CD20 (green), CD56 (cyan), FoxP3 (yellow). (C) Distribution of the patient's test results in the total HCC population test data (total: 40 patients). Left: the number of immune cells. Right: the positive rate of immune cells. The red triangle represents the patient's test results.
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Compared with the immune cell test data of the total HCC population, the test result of this patient was much higher than the average value of them, except for regulatory T cells ( Figures 2A, C ). M2 macrophages and CD56dim natural killer (NK) cells. Moreover, mIF staining of CD3 and CD20 reveals the high density of B cells and the presence of TLS in the HCC tumor (0.21/mm2; 11503.03 microm2/mm2;  Figure 2B ).