Clinical Scorecard: Case Study: Thoracic Spinal Metastasis Observed Without Clear Intrahepatic Recurrence Following Conversion Therapy and Hepatectomy in Hepatocellular Carcinoma

At a Glance

Key Highlights

• Patient developed thoracic spinal metastasis despite effective intrahepatic control.
• Rising alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) levels indicated potential extrahepatic progression.
• PET/CT identified a destructive vertebral lesion leading to spinal cord compression.
• Prompt imaging and multidisciplinary evaluation are critical to prevent neurological deterioration.

Guideline-Based Recommendations

Diagnosis

• Monitor AFP and DCP levels post-treatment for signs of extrahepatic progression.

Management

• Consider systemic restaging with imaging upon rising tumor markers despite negative liver imaging.

Monitoring & Follow-up

• Regular follow-up imaging (CT/MRI) and laboratory assessments for tumor markers.

Risks

• Risk of neurological injury due to delayed detection of spinal metastases.

Patient & Prescribing Data

61-year-old man with hepatitis B-related cirrhosis and multifocal HCC.

Combination of TACE, lenvatinib, and tislelizumab followed by hepatectomy.

Clinical Best Practices

• Implement routine surveillance for extrahepatic disease in HCC patients post-treatment.
• Utilize PET/CT for early detection of bone metastases in patients with rising tumor markers.

Related Resources & Content

• CARE reporting checklist