Zhang Y, Zhang LY, Meng B, Wang YJ, Yang NM, Li Q, Zhang M. Successful conversion therapy for advanced hepatocellular carcinoma with biliary tumor thrombus and bilateral lobe involvement: A case report. World J Gastroenterol 2026; 32(24): 119220 [DOI: 10.3748/wjg.v32.i24.119220]
Corresponding Author of This Article
Min Zhang, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, No. 127 Dongming Road, Zhengzhou 450008, Henan Province, China. zhangyuu2022@gs.zzu.edu.cn
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Surgery
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case-report
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Zhang Y, Zhang LY, Meng B, Wang YJ, Yang NM, Li Q, Zhang M. Successful conversion therapy for advanced hepatocellular carcinoma with biliary tumor thrombus and bilateral lobe involvement: A case report. World J Gastroenterol 2026; 32(24): 119220 [DOI: 10.3748/wjg.v32.i24.119220]
World J Gastroenterol. Jun 28, 2026; 32(24): 119220 Published online Jun 28, 2026. doi: 10.3748/wjg.v32.i24.119220
Successful conversion therapy for advanced hepatocellular carcinoma with biliary tumor thrombus and bilateral lobe involvement: A case report
Yu Zhang, Lu-Yang Zhang, Bo Meng, Yun-Jian Wang, Nan-Mu Yang, Qiong Li, Min Zhang
Yu Zhang, Lu-Yang Zhang, Bo Meng, Yun-Jian Wang, Nan-Mu Yang, Min Zhang, Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450008, Henan Province, China
Qiong Li, North Henan Medical University, Xinxiang 453003, Henan Province, China
Author contributions: Zhang Y and Zhang LY contributed to the manuscript writing, editing, and data collection; Wang YJ, Yang NM, and Meng B contributed to the data analysis; Li Q and Zhang M contributed to the conceptualization and supervision of the overall project; all authors have read and approved the final manuscript.
AI contribution statement: We only used AI tools such as Grammarly and DeepL to modify English grammar and polish the language expression of this manuscript. The entire manuscript was independently drafted and revised by the author, and all content was not generated by AI. AI tools are only used for language polishing and assisted translation, and do not involve data analysis or manuscript content writing. The research design and result interpretation were independently completed by the authors without the involvement of any AI tools. There are no numbers or images generated by AI in this manuscript.
Supported by Henan Province Science and Technology Research Project, No. SBGJ202103035.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Min Zhang, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, No. 127 Dongming Road, Zhengzhou 450008, Henan Province, China. zhangyuu2022@gs.zzu.edu.cn
Received: January 22, 2026 Revised: February 12, 2026 Accepted: March 12, 2026 Published online: June 28, 2026 Processing time: 139 Days and 7 Hours
Abstract
BACKGROUND
Bilateral multilobular hepatocellular carcinoma (HCC) complicated by HCC-derived biliary tumor thrombus is classified as an advanced-stage disease. Owing to the heavy tumor burden, obstructive jaundice, and other issues, the prognosis with conventional treatment is extremely poor, and most patients lose the opportunity for radical resection. The advent of immune-combined targeted conversion therapy has brought new hope for such patients.
CASE SUMMARY
A 36-year-old man with ≥ 10-year history of hepatitis B was admitted for upper abdominal distension and pain. Imaging demonstrated bilateral multifocal HCC with a left HCC-derived biliary tumor thrombus (Chinese Liver Cancer stage IIIa, Barcelona Clinic Liver Cancer stage C), obstructive jaundice, and cirrhosis. The tumor was initially considered unresectable. The patient received conversion therapy with camrelizumab, apatinib mesylate, and radiofrequency ablation. After five cycles, both the tumors and thrombus regressed, and tumor marker levels decreased markedly. The response was assessed as partial response according to mRECIST 1.1 criteria. Liver function improved from Child-Pugh class B to class A, allowing radical surgical resection with negative margins. Postoperative maintenance therapy was administered for 1 year. No recurrence was detected during follow-up.
CONCLUSION
For advanced bilateral multi-lobular HCC complicated by HCC-derived biliary tumor thrombus, immune-targeted therapy combined with local ablation reduces tumor burden, eliminates thrombus, converts unresectable disease to resectable status, and achieves effective short-term disease control.
Core Tip: For advanced bilateral multilobular hepatocellular carcinoma (HCC) with HCC-derived biliary tumor thrombus, conversion therapy using camrelizumab (immunotherapy) combined with apatinib mesylate (targeted therapy) and hepatic radiofrequency ablation successfully reduced tumor burden and eliminated the biliary tumor thrombus, enabling radical surgical resection. This approach resulted in short-term disease-free survival (6 months after surgery) with preserved normal liver function.
