PMC10166873_01
Radiological response evaluation of the liver during the clinical course. (A) Contrast-enhanced magnetic resonance imaging (MRI) revealed enhanced subcapsular hepatocellular carcinoma (HCC) lesions in the hepatic S6 (white arrowhead). (B) Contrast-enhanced MRI revealed that the lesion in hepatic S6 was not enhanced in the arterial phase (white arrowhead) 1 month after transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA). (C) An enhanced small nodule around the previous one (white arrowhead) was detected by MRI three months after TACE and RFA. (D) Contrast-enhanced MRI showed no active lesions in the liver (white arrowhead) 3 months after surgical resection of the liver metastases. (E) Complete response (CR) was confirmed by contrast-enhanced MRI, which showed no active lesions in the liver (white arrowhead) after RFA and four cycles of tislelizumab treatment. (F) MRI obtained 15 months after tislelizumab treatment initiation showed that there were still no active lesions (white arrowhead) in the liver or new lesion.
fimmu-14-1163656-g001.jpg
PMC10166873_01_fimmu-14-1163656-g001.jpg
f1
The patient received transcatheter arterial chemoembolization (TACE) (with 20 mg of CalliSpheres  beads [100-300 microm in diameter], 20 mg of lobaplatin, and 4 mL of lipiodol) and radiofrequency ablation (RFA), which resulted in a complete radiological response according to the Response Evaluation Criteria in Solid Tumors (version 1.1) (RECIST 1.1) ( Figure 1B ). Contrast-enhanced MRI showed an enhanced small nodule with a diameter of 0.6 cm at the same location as the original tumor, and multiple enlarged ALNs ( Figures 1C ,  2A ) on July 26, 2021, indicating that the cancer had progressed to BCLC stage C. Two months later, a contrast-enhanced MRI showed no active lesions in the liver ( Figures 1D ,  2B ). ALNs (<=10 mm) ( Figures 1E ,  2C ) assessed by RECIST 1.1. Although the patient experienced fatigue and developed skin rashes with pruritus over the entire body, he was cured by symptomatic treatment. By January 9, 2023, the patient had been in complete remission for ~15 months without evidence of tumor relapse ( Figures 1F ,  2D ).
Radiological response evaluation of abdominal lymph nodes during the clinical course. (A) Contrast-enhanced magnetic resonance imaging (MRI) revealed multiple enlarged abdominal lymph nodes (red arrow). (B) Contrast-enhanced MRI showed that there were still multiple enlarged abdominal lymph nodes (red arrow) 3 months after surgical resection of lymph nodes in the hilar area. (C) Contrast-enhanced MRI showed that the size of the abdominal lymph nodes was reduced after RFA and four cycles of tislelizumab treatment (red arrow). (D) A significant reduction in the size of the abdominal lymph nodes (<=10 mm) was seen 15 months after tislelizumab treatment initiation (red arrow).
fimmu-14-1163656-g002.jpg
PMC10166873_01_fimmu-14-1163656-g002.jpg
f2
Contrast-enhanced MRI showed an enhanced small nodule with a diameter of 0.6 cm at the same location as the original tumor, and multiple enlarged ALNs ( Figures 1C ,  2A ) on July 26, 2021, indicating that the cancer had progressed to BCLC stage C. Two months later, a contrast-enhanced MRI showed no active lesions in the liver ( Figures 1D ,  2B ). ALNs (<=10 mm) ( Figures 1E ,  2C ) assessed by RECIST 1.1. Although the patient experienced fatigue and developed skin rashes with pruritus over the entire body, he was cured by symptomatic treatment. By January 9, 2023, the patient had been in complete remission for ~15 months without evidence of tumor relapse ( Figures 1F ,  2D ).
Histological findings of the liver at autopsy (hematoxylin and eosin staining). The pathological diagnosis is hepatocellular carcinoma.
fimmu-14-1163656-g003.jpg
PMC10166873_01_fimmu-14-1163656-g003.jpg
f3
The pathology indicated the recurrent lesion as poorly differentiated high-grade HCC ( Figure 3 ).
Positron emission tomography-computer tomography showed that glucose metabolism was significantly increased in the liver and abdominal lymph node lesions 3 months after surgical resection of HCC lesions and lymph nodes in the hilar area (red arrows).
fimmu-14-1163656-g004.jpg
PMC10166873_01_fimmu-14-1163656-g004.jpg
f4
These findings implied cancer recurrence ( Figure 4 ).
The treatment timeline. HCC, hepatocellular carcinoma; BCLC, Barcelona Clinic Liver Cancer. TACE, transcatheter arterial chemoembolization; RFA, radiofrequency ablation; MRI, magnetic resonance imaging; PET-CT, positron emission tomography-computer tomography; FDG, fluorodeoxyglucose; CR, complete response.
fimmu-14-1163656-g005.jpg
PMC10166873_01_fimmu-14-1163656-g005.jpg
f5
Table 1 ). The patient's treatment timeline is shown in  Figure 5 .