{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:09:06Z","timestamp":1788930546921,"version":"build-2803163510"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Conversion therapy followed by hepatectomy can achieve intrahepatic control in selected patients with hepatocellular carcinoma (HCC), but occult extrahepatic progression may be missed when surveillance remains centered on the liver.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A 61-year-old man with hepatitis B-related multifocal HCC underwent transarterial chemoembolization, lenvatinib, four documented preoperative cycles of tislelizumab, and subsequent hepatectomy. Pathology showed treatment-related response, negative margins, and no microvascular invasion. During scheduled surveillance, alpha-fetoprotein and des-gamma-carboxy prothrombin increased progressively despite no definite intrahepatic recurrence on available liver imaging. PET\/CT later revealed a destructive T2 vertebral lesion. After local radiotherapy, no dedicated spine MRI or multidisciplinary spinal assessment was performed before neurological deterioration. At emergency admission, lower-limb strength was initially preserved on the right and partially reduced on the left, followed by rapid bilateral paralysis. Contrast-enhanced thoracic MRI showed multilevel metastases with a dominant T8 lesion causing epidural spinal cord compression and pathological fracture. Fixation and decompression relieved radiological compression, but severe motor and autonomic dysfunction persisted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The clinical value of this case lies in a surveillance gap rather than rarity alone. Persistent AFP\/DCP elevation with negative liver imaging should prompt systemic restaging for occult extrahepatic disease. Once a destructive vertebral lesion is detected, early spine MRI and multidisciplinary assessment of stability and epidural compression are warranted before irreversible neurological injury develops.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1931013","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:45:25Z","timestamp":1788929125000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Thoracic spinal metastasis without definite intrahepatic recurrence after conversion therapy and hepatectomy for hepatocellular carcinoma"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiahui","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Pathology, Shaoxing People\u2019s Hospital","place":["Shaoxing, Zhejiang, China"]},{"name":"School of Medicine, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhua","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine, Shaoxing University","place":["Shaoxing, Zhejiang, China"]},{"name":"Department of Ultrasound, Shaoxing People\u2019s Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Difan","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Medicine, Shaoxing University","place":["Shaoxing, Zhejiang, China"]},{"name":"Department of Hepatobiliary and Pancreatic Surgery, Shaoxing People\u2019s Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.943866","article-title":"Emerging perspectives of bone metastasis in hepatocellular carcinoma","volume":"12","author":"Yuan","year":"2022","journal-title":"Front Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s11684-022-0928-z","article-title":"Bone metastasis of hepatocellular carcinoma: facts and hopes from clinical and translational perspectives","volume":"16","author":"Huang","year":"2022","journal-title":"Front Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.wneu.2016.04.026","article-title":"A systematic review of metastatic hepatocellular carcinoma to the spine","volume":"91","author":"Goodwin","year":"2016","journal-title":"World Neurosurg"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.15708","article-title":"Outcomes of metastatic spinal cord compression secondary to primary hepatocellular carcinoma with multidisciplinary treatments","volume":"8","author":"He","year":"2017","journal-title":"Oncotarget"},{"key":"B5","doi-asserted-by":"publisher","first-page":"12984","DOI":"10.1038\/s41598-021-92503-6","article-title":"Simple parameters predicting extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma","volume":"11","author":"Yoon","year":"2021","journal-title":"Sci Rep"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.10100672","article-title":"PET\/CT characteristics of isolated bone metastases in hepatocellular carcinoma","volume":"258","author":"Ho","year":"2011","journal-title":"Radiology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000466","article-title":"AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma","volume":"78","author":"Singal","year":"2023","journal-title":"Hepatology"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181e16ae2","article-title":"A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group","volume":"35","author":"Fisher","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability analysis of the epidural spinal cord compression scale","volume":"13","author":"Bilsky","year":"2010","journal-title":"J Neurosurg Spine"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.10.226","article-title":"Surgical outcomes and prognostic factors for metastatic spine hepatocellular carcinoma","volume":"122","author":"Wang","year":"2019","journal-title":"World Neurosurg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1931013\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:45:49Z","timestamp":1788929149000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1931013\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":10,"alternative-id":["10.3389\/fonc.2026.1931013"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1931013","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"1931013"}}