Case report of curative resection after preoperative bevacizumab and sintilimab therapy in hepatocellular carcinoma with lymph node metastasis

Hepatocellular carcinoma with lymph node metastasis (HCC-LNM) is relatively rare, and optimal management remains controversial. We report two cases of HCC with lymph node metastasis treated with three cycles of Sintilimab and Bevacizumab therapy. The metastatic lymph nodes demonstrated partial shrinkage, with extensive coagulative necrosis and complete absence of viable tumor cells. Primary liver lesions demonstrated a partial response to systemic therapy. Both patients subsequently achieved curative resection. No recurrence occurred during postoperative follow-up (20 months for Case 1; 16 months for Case 2). Collectively, preoperative immunotherapy and targeted therapy has the potential to enable curative outcomes in patients with solitary HCC lymph node metastasis, although validation in larger studies is required.