ArticleSurgical case reports2025
Conversion Surgery Following Durvalumab Plus Tremelimumab in Unresectable Hepatocellular Carcinoma with Para-Aortic Lymph Node Metastases: A Case of Complete Hepatic Response and Lymphatic Resistance.
Article in Surgical case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Pathologic Complete Response to Neoadjuvant Dual Checkpoint Blockade with Durvalumab Plus Tremelimumab in Advanced-Stage HCC: A Case Report.Journal of hepatocellular carcinoma · 2026Article
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9 authors.
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Abstract
introductionRecent advances in immune checkpoint inhibitor (ICI) therapy have made conversion surgery possible in selected patients with unresectable hepatocellular carcinoma (uHCC); however, outcomes in cases with extrahepatic spread remain unclear. CASE PRESENTATION: A 77-year-old man with hepatitis B-associated uHCC presented with a 60 mm tumor in the posterior section of the liver with several daughter nodules and multiple enlarged para-aortic lymph nodes (PALNs). Durvalumab plus tremelimumab was chosen over atezolizumab plus bevacizumab because of the patient's concurrent anticoagulant therapy for atrial fibrillation, which raised concerns about bleeding risk. Tumor markers (alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II) returned to normal after three cycles, and imaging demonstrated significant shrinkage of both the primary tumor and the lymph nodes. After nine treatment cycles, the primary tumor had further decreased to 25 mm without daughter nodules; however, two PALNs demonstrated regrowth. The patient subsequently underwent a subsegmentectomy of segment 6 and lymphadenectomy of the PALNs. Histopathological examination revealed a complete pathological response (pCR) in the liver tumor, with no viable tumor cells. However, metastatic lymph nodes contained viable undifferentiated carcinoma cells that were negative for hepatocellular markers (HepPar-1 and arginase-1) but positive for CAM5.2 and vimentin, indicating a treatment-resistant component. Twelve months postoperatively, the patient remained recurrence-free with preserved liver function and good general condition.
conclusionsThis case demonstrates a discrepant therapeutic response, with a pCR in the liver contrasted with residual undifferentiated carcinoma in the PALNs. To our knowledge, this is the first reported HCC case demonstrating hepatic pCR after ICI therapy with residual undifferentiated carcinoma confined to the PALNs, highlighting immune-resistant extrahepatic clones and the diagnostic-therapeutic value of conversion surgery.
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