肝内胆管细胞癌的诊疗现状与思考

夏龙; 夏医君; 张磊; 朱曙光; 武慧军; 李华; 陈规划

doi:10.3969/j.issn.1001-5256.2020.10.048

肝内胆管细胞癌的诊疗现状与思考

DOI: 10.3969/j.issn.1001-5256.2020.10.048

1. 中山大学附属第三医院肝脏外科暨肝脏移植中心
2. 内蒙古自治区人民医院肝胆胰脾外科
3. 中山大学附属第三医院胆胰外科

基金项目:

国家自然科学基金(81172038)；

详细信息

中图分类号: R735.7
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- 被引次数: 0
出版历程
- 收稿日期: 2020-04-24
- 出版日期: 2020-10-20

Diagnosis and treatment of intrahepatic cholangiocarcinoma: Current status and thoughts

Department of Hepatic Surgery & Liver Transplantation Center,The Third Affiliated Hospital of Sun Yat-Sen University
Department of Hepatobiliary-Pancreatic-Splenic Surgery,The People's Hospital of Inner Mongolia Autonomous Region
Department of Biliary-Pancreatic Surgery,The Third Affiliated Hospital of Sun Yat-Sen University

Research funding:

摘要

摘要: 肝内胆管细胞癌(ICC)是发生率仅次于肝细胞癌极具恶性生物学行为的原发性肝癌,近年来,发生率及病死率均呈明显升高趋势。由于生物学特性与肝细胞癌和肝外胆管癌存在显著差异,不仅缺乏特征性临床症状和肿瘤标志物,且侵袭性强,手术切除率低,术后易复发转移,致使总体预后极差。随着分子生物学技术的发展及诊疗经验的累积,对ICC的生物学特性及临床转归认识的逐渐深入,相应的外科诊疗策略和技术手段正发生着深刻变革,当前基于多学科讨论以手术为主的综合治疗是ICC主流治疗模式,强调R0切除和区域性淋巴结清扫有助于提高疗效、改善预后。然而在实现对ICC早期诊断、精准化、规范化、个性化治疗的道路上,尚存一些值得深思的问题。
- 胆管上皮癌 /
- 异质性 /
- 早期诊断 /
- 治疗学
Abstract: Intrahepatic cholangiocarcinoma( ICC) is a primary liver cancer with malignant biological behaviors and ranks only second to hepatocellular carcinoma in incidence rate,and in recent years,the incidence and mortality rates of ICC have been increasing significantly.Since ICC has significant different biological characteristics from hepatocellular carcinoma and extrahepatic cholangiocarcinoma,ICC lacks characteristic clinical symptoms and specific tumor markers and has strong invasion,a low surgical resection rate,and a tendency of recurrence and metastasis after surgery,which results in poor overall prognosis. With the development of molecular biology techniques and the accumulation of diagnosis and treatment experience,there is a gradually deepened understanding of the biological characteristics and clinical outcomes of ICC,and the corresponding surgical diagnosis and treatment strategies and technical means are undergoing profound transformation. At present,multidisciplinary comprehensive treatment,mainly surgery,is the mainstream paradigm for the treatment of ICC,and emphasis on R0 resection and regional lymph node dissection helps to improve clinical outcome and prognosis. However,there are still some problems for consideration on the way to the early diagnosis and the precise,standardized,and individualized treatment of ICC.
- cholangiocarcinoma /
- heterogeneity /
- early diagnosis /
- therapeutics

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参考文献(44)

[1] von HAHN T,CIESEK S,WEGENER G,et al. Epidemiological trends in incidence and mortality of hepatobiliary cancers in Germany[J]. Scand J Gastroenterol,2011,46(9):1092-1098.

[2] RAOOF M,SINGH G. Rising trends in intrahepatic cholangiocarcinoma incidence and mortality:Getting at the root cause[J]. Hepatobiliary Surg Nutr,2019,8(3):301-303.

[3] Liver Cancer Study Group of Japan. Primary liver cancer in Japan clinicopathologic features and results of surgical treatment[J]. Ann Surg,1990,211(3):277-287.

[4] CHEN JJ,LI WG. An excerpt of(2016)cholangiocarcinoma:Current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma(ENS-CCA)[J]. J Clin Hepatol,2016,32(10):1847-1850.(in Chinese)陈嘉佳，李文岗．《2016年欧洲胆管癌研究网络共识:胆管细胞癌研究现状及前景展望》摘译[J]．临床肝胆病杂志，2016,32(10):1847-1850.

[5] SAHA SK,ZHU AX,FUCHS CS,et al. Forty-year trends in cholangiocarcinoma incidence in the U. S.:Intrahepatic disease on the rise[J]. Oncologist,2016,21(5):594-599.

[6] BRIDGEWATER J,GALLE PR,KHAN SA,et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma[J]. J Hepatol,2014,60(6):1268-1289.

[7] PENG NF,LI LQ,QIN X,et al. Evaluation of risk factors and clinicopathologic features for intrahepatic cholangiocarcinoma in Southern China:A possible role of hepatitis B virus[J]. Ann Surg Oncol,2011,18(5):1258-1266.

[8] GRAINGE MJ,WEST J,SOLAYMANI-DODARAN M,et al.The antecedents of biliary cancer:A primary care case-control study in the United Kingdom[J]. Br J Cancer,2009,100(1):178-180.

[9] SEMPOUX C,JIBARA G,WARD SC,et al. Intrahepatic cholangiocarcinoma:New insights in pathology[J]. Semin Liver Dis,2011,31(1):49-60.

[10] ZHANG XF,CHAKEDIS J,BAGANTE F,et al. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma[J]. Br J Surg,2018,105(7):857-866.

[11] RUZZENENTE A,CONCI S,VIGANL,et al. Role of lymph node dissection in small(≤3 cm)intrahepatic cholangiocarcinoma[J]. J Gastrointest Surg,2019,23(6):1122-1129.

[12] ARIIZUMI S,KOTERA Y,KATAGIRI S,et al. Long-term survival of patients with cholangiolocellular carcinoma after curative hepatectomy[J]. Ann Surg Oncol,2014,21 Suppl 3:s451-s458.

[13] TANG ZH,QUAN ZW. Surgical and comprehensive treatment for intrahepatic cholangiocarcinoma patients from the perspective of tumor heterogeneity[J]. Chin J Surg,2018,56(5):328-331.(in Chinese)汤朝晖，全志伟．从肿瘤异质性看肝内胆管细胞癌外科及综合治疗的策略选择[J]．中华外科杂志，2018,56(5):328-331.

[14] SEEHAWER M,HEINZMANN F,D’ARTISTA L,et al. Necroptosis microenvironment directs lineage commitment in liver cancer[J]. Nature,2018,562(7725):69-75.

[15] SIA D,HOSHIDA Y,VILLANUEVA A,et al. Integrative molecular analysis of intrahepatic cholangiocarcinoma reveals 2 classes that have different outcomes[J]. Gastroenterology,2013,144(4):829-840.

[16] ZOU S,LI J,ZHOU H,et al. Mutational landscape of intrahepatic cholangiocarcinoma[J]. Nat Commun,2014,5:5696.

[17] GOYAL L,GOVINDAN A,SHETH RA,et al. Prognosis and clinicopathologic features of patients with advanced stage isocitrate dehydrogenase(IDH)mutant and IDH wild-type intrahepatic cholangiocarcinoma[J]. Oncologist,2015,20(9):1019-1027.

[18] SINGH S,TANG SJ,SREENARASIMHAIAH J,et al. The clinical utility and limitations of serum carbohydrate antigen(CA19-9)as a diagnostic tool for pancreatic cancer and cholangiocarcinoma[J]. Dig Dis Sci,2011,56(8):2491-2496.

[19] XU HX,CHEN LD,LIU LN,et al. Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma:Correlation with pathological examination[J]. Br J Radiol,2012,85(1016):1029-1037.

[20] VALLS C,GUMA,PUIG I,et al. Intrahepatic peripheral cholangiocarcinoma:CT evaluation[J]. Abdom Imaging,2000,25(5):490-496.

[21] ZHAO YJ,CHEN WX,WU DS,et al. Differentiation of massforming intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma:Based on the multivariate analysis of contrast-enhanced computed tomography findings[J]. Abdom Radiol(NY),2016,41(5):978-989.

[22] KIM SA,LEE JM,LEE KB,et al. Intrahepatic mass-forming cholangiocarcinomas:Enhancement patterns at multiphasic CT,with special emphasis on arterial enhancement pattern—correlation with clinicopathologic findings[J]. Radiology,2011,260(1):148-157.

[23] YONG EC,KIM MJ,PARK YN,et al. Varying appearances of cholangiocarcinoma radiologicpathologic correlation[J]. Radio Graphics,2009,29(3):683-700.

[24] YOSHIMITSU K. Differentiation of two subtypes of intrahepatic cholangiocarcinoma:Imaging approach[J]. Eur Radiol,2019,29(6):3108-3110.

[25] JIANG L,TAN H,PANJE CM,et al. Role of 18F-FDG PET/CT imaging in intrahepatic cholangiocarcinoma[J]. Clin Nucl Med,2016,41(1):1-7.

[26] OKABAYASHI T,YAMAMOTO J,KOSUGE T,et al. A new staging system for mass-forming intrahepatic cholangiocarcinoma:Analysis of preoperative and postoperative variables[J]. Cancer,2001,92(9):2374-2383.

[27] YAMASAKI S. Intrahepatic cholangiocarcinoma:Macroscopic type and stage classification[J]. J Hepatobiliary Pancreat Surg,2003,10(4):288-291.

[28] NATHAN H,ALOIA TA,VAUTHEY JN,et al. A proposed staging system for intrahepatic cholangiocarcinoma[J]. Ann Surg Oncol,2009,16(1):14-22.

[29] MENG ZW,PAN W,HONG HJ,et al. Macroscopic types of intrahepatic cholangiocarcinoma and the eighth edition of AJCC/UICC TNM staging system[J]. Oncotarget,2017,8(60):101165-101174.

[30] WANG Y,LI J,XIA Y,et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy[J]. J Clin Oncol,2013,31(9):1188-1195.

[31] WEBER SM,RIBERO D,O’REILLY EM,et al. Intrahepatic cholangiocarcinoma:Expert consensus statement[J]. HPB(Oxford),2015,17(8):669-680.

[32] STOCKMANN M,BEDNARSCH J,MALINOWSKI M,et al. Functional considerations in ALPPS-consequences for clinical management[J]. HPB(Oxford),2017,19(11):1016-1025.

[33] ZHANG XF,BEAL EW,BAGANTE F,et al. Early versus late recurrence of intrahepatic cholangiocarcinoma after resection with curative intent[J]. Br J Surg,2018,105(7):848-856.

[34] BERGEAT D,SULPICE L,RAYAR M,et al. Extended liver resections for intrahepatic cholangiocarcinoma:Friend or foe?[J]. Surgery,2015,157(4):656-665.

[35] HOYOS S,NAVAS MC,RESTREPO JC,et al. Current controversies in cholangiocarcinoma[J]. Biochim Biophys Acta Mol Basis Dis,2018,1864(4 Pt B):1461-1467.

[36] SHEN F,ZHANG H,YANG T,et al. The comprehensive surgical management for intrahepatic cholangiocarcinoma[J].Chin J Dig Surg,2018,17(3):213-218.(in Chinese)沈锋，张汉，杨田，等．肝内胆管癌的外科综合治疗[J]．中华消化外科杂志，2018,17(3):213-218.

[37] LI DY,ZHANG HB,YANG N,et al. Routine lymph node dissection may be not suitable for all intrahepatic cholangiocarcinoma patients:Results of a monocentric series[J]. World J Gastroenterol,2013,19(47):9084-9091.

[38] AMINI N,EJAZ A,SPOLVERATO G,et al. Management of lymph nodes during resection of hepatocellular carcinoma and intrahepatic cholangiocarcinoma:A systematic review[J]. J Gastrointest Surg,2014,18(12):2136-2148.

[39] MORINE Y,SHIMADA M. The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics[J]. J Gastroenterol,2015,50(9):913-927.

[40] CHEN YX,ZENG ZC,TANG ZY,et al. Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma:A retrospective analysis of 84 patients[J]. BMC Cancer,2010,10:492.

[41] VALLE JW,WASAN H,JOHNSON P,et al. Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours:A multicentre randomised phase II study-The UK ABC-01 Study[J].Br J Cancer,2009,101(4):621-627.

[42] ABDEL-RAHMAN O,ELSAYED Z,ELHALAWANI H. Gemcitabine-based chemotherapy for advanced biliary tract carcinomas[J]. Cochrane Database Syst Rev, 2018, 4:CD011746.

[43] GOYAL L,SAHA SK,LIU LY,et al. Polyclonal secondary FGFR2 mutations drive acquired resistance to FGFR inhibition in patients with FGFR2 fusion-positive cholangiocarcinoma[J].Cancer Discov,2017,7(3):252-263.

[44] TARIQ NU,MCNAMARA MG,VALLE JW. Biliary tract cancers:Current knowledge,clinical candidates and future challenges[J]. Cancer Manag Res,2019,11:2623-2642.

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