多发性双侧肺转移性肝细胞癌（HCC）主要采用分子治疗进行治疗。阿特珠单抗加贝伐单抗可为反应良好的患者提供出色的长期生存。本文报告一例 67 岁女性患者，首次行右肝切除术，切除直径为 11cm 的原发单发 HCC 后经过门静脉栓塞术。2 年后，患者发展为双侧肺转移，并出现了>100 个直径<1cm 的结节。患者无病毒性肝炎或肝硬化，肝功能临床分级为 A 类（5 分）。首次线治疗用了雷伐替尼（12mg每日），治疗持续 18 个月，最佳反应为稳定性疾病（SD）。随后每三周静脉注射阿特珠单抗（1,200 mg）加贝伐单抗（15 mg/kg）治疗。最佳反应为 SD，治疗持续 26 个月。之后开始卡博替尼治疗，并在一周期后停药。随后，用双重免疫检查点抑制剂（D+T）（杜瓦卢单抗 + 曲美曲单抗）治疗。患者 4 年来肺转移多次，但仅限于肺部。作为门诊患者，患者肝功能处于 A 级，体力状态为 0。即使阿特珠单抗加贝伐单抗不能引起良好的反应，持久的稳定性疾病仍能延长肝细胞癌转移患者的生存时间，同时保持肝功能和较好的生活质量。版权所有©2023 International Institute of Anticancer Research (Dr. George J. Delinasios)。保留所有权利。

Multiple bilateral lung metastases secondary to hepatocellular carcinoma (HCC) are mainly treated with molecular therapy. Atezolizumab plus bevacizumab can provide excellent long-term survival for patients with a good response.A 67-year-old woman underwent right hepatectomy for a primary solitary HCC, 11 cm in diameter, after portal embolization. After 2 years, she developed bilateral lung metastases with >100 nodules, <1 cm in size. She had no viral hepatitis or liver cirrhosis, and the Child-Pugh Grade was A (5 points). Lenvatinib (12 mg daily) was administered as a first-line treatment and continued for 18 months. The best response was stable disease (SD). Subsequently, intravenous atezolizumab (1,200 mg) plus bevacizumab (15 mg/kg) was administered once every three weeks. The best response was SD, which continued for 26 months. After that, cabozantinib treatment was initiated and discontinued after one cycle. Subsequently, dual immune checkpoint inhibitor treatment (durvalumab + tremelimumab) was administered. She has had multiple, but lung-only, metastases over four years. She has been well as an outpatient with the Child-Pugh Grade of A and a performance status of 0.Even if atezolizumab plus bevacizumab does not induce a good response, a durable SD could prolong survival in patients with metastatic HCC while maintaining liver function and a good quality-of-life.Copyright © 2023, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.