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中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (06) : 537 -541. doi: 10.3877/cma.j.issn.2095-3232.2022.06.001

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不可切除肝内胆管细胞癌转化治疗策略
方诚1, 夏勇1, 沈锋1,()   
  1. 1. 200438 上海,海军军医大学第三附属医院肝外四科
  • 收稿日期:2022-08-25 出版日期:2022-12-10
  • 通信作者: 沈锋
  • 基金资助:
    上海市临床重点专科建设项目(shslczdzk02402); 上海市申康医院发展中心项目(SHDC2020CR5007)

Conversion therapy strategies for unresectable intrahepatic cholangiocarcinoma

Cheng Fang1, Yong Xia1, Feng Shen1()   

  • Received:2022-08-25 Published:2022-12-10
  • Corresponding author: Feng Shen
引用本文:

方诚, 夏勇, 沈锋. 不可切除肝内胆管细胞癌转化治疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2022, 11(06): 537-541.

Cheng Fang, Yong Xia, Feng Shen. Conversion therapy strategies for unresectable intrahepatic cholangiocarcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(06): 537-541.

肝内胆管细胞癌(ICC)是肝脏的第二大恶性肿瘤,发病率仅次于肝细胞癌,占肝脏肿瘤的10%~25%,我国ICC发病率7.45~7.55/10万[1,2]。ICC的发病机制尚不明确,炎症-肿瘤机制、干细胞起源假说等均可能是其重要潜在机制。目前认为肝内胆管结石、原发性硬化性胆管炎、病毒性肝炎、先天性胆道异常、毒性物质和职业暴露等均与ICC的发病相关[3]。手术切除仍是ICC最有效的治疗方式,术后5年生存率20%~40%,而无法手术的患者5年生存率仅为5%~10%[4,5]。由于ICC早期症状缺乏特异性,且易出现淋巴结转移和血管侵犯,大部分患者因腹痛、黄疸等就诊时已失去手术机会,根治性手术切除率仅为30%[6]。因此,提高手术切除率是改善ICC患者生存率的重要途径。

[1]
Lee AJ, Chun YS. Intrahepatic cholangiocarcinoma: the AJCC/UICC 8th edition updates[J]. Chin Clin Oncol, 2018, 7(5):52.
[2]
Massarweh NN, El-Serag HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Cancer Control, 2017, 24(3):1073274817729245.
[3]
Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma[J]. Gastroenterology, 2013, 145(6):1215-1229.
[4]
Benson AB, D'Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19(5):541-565.
[5]
Kamarajah S, Giovinazzo F, Roberts KJ, et al. The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: review of literature and pooled analysis[J]. Ann Hepatobiliary Pancreat Surg, 2020, 24(1):6-16.
[6]
Buettner S, Galjart B, van Vugt JLA, et al. Performance of prognostic scores and staging systems in predicting long-term survival outcomes after surgery for intrahepatic cholangiocarcinoma[J]. J Surg Oncol, 2017, 116(8):1085-1095.
[7]
中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识(2021版)[J]. 中华消化外科杂志, 2021, 20(6):600-616.
[8]
王之伟, 郑俊玲, 李江涛, 等. 肝内胆管癌的转化治疗[J]. 生物医学转化, 2020, (1) 26-34.
[9]
Weber SM, Ribero D, O'Reilly EM, et al. Intrahepatic cholangiocarcinoma: expert consensus statement[J]. HPB, 2015, 17(8):669-680.
[10]
吴军, 琴瀚姣, 盛基尧, 等. 不可切除肝内胆管细胞癌诊疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(1):1-5.
[11]
李起, 张瑞, 张景玮, 等. 术前外周血肝纤维化血清学指标对肝内胆管癌预后预测价值研究[J]. 中国实用外科杂志, 2021, 41(7):778-785.
[12]
Fong ZV, Brownlee SA, Qadan M, et al. The clinical management of cholangiocarcinoma in the United States and Europe: a comprehensive and evidence-based comparison of guidelines[J]. Ann Surg Oncol, 2021, 28(5):2660-2674.
[13]
Riby D, Mazzotta AD, Bergeat D, et al. Downstaging with radioembolization or chemotherapy for initially unresectable intrahepatic cholangiocarcinoma[J]. Ann Surg Oncol, 2020, 27(10): 3729-3737.
[14]
Shroff RT, Javle MM, Xiao L, et al. Gemcitabine, cisplatin, andnab-paclitaxel for the treatment of advanced biliary tract cancers: a phase 2 clinical trial[J]. JAMA Oncol, 2019, 5(6):824-830.
[15]
Mazzaferro V, Gorgen A, Roayaie S, et al. Liver resection and transplantation for intrahepatic cholangiocarcinoma[J]. J Hepatol, 2020, 72(2):364-377.
[16]
Bekaii-Saab TS, Valle JW, Van Cutsem E, et al. FIGHT-302: first-line pemigatinib vs gemcitabine plus cisplatin for advanced cholangiocarcinoma with FGFR2 rearrangements[J]. Future Oncol, 2020, 16(30):2385-2399.
[17]
Abou-Alfa GK, Macarulla T, Javle MM, et al. Ivosidenib in IDH1-mutant, chemotherapy-refractory cholangiocarcinoma (ClarIDHy): a multicentre, randomised, double-blind, placebo-controlled, phase 3 study[J]. Lancet Oncol, 2020, 21(6):796-807.
[18]
Loaiza-Bonilla A, Clayton E, Furth E, et al. Dramatic response to dabrafenib and trametinib combination in a BRAF V600E-mutated cholangiocarcinoma: implementation of a molecular tumour board and next-generation sequencing for personalized medicine[J]. Ecancermedicalscience, 2014(8):479.
[19]
Ricci AD, Rizzo A, Bonucci C, et al. PARP inhibitors in biliary tract cancer: a new kid on the block?[J]. Medicines, 2020, 7(9):54.
[20]
Overman MJ, Lonardi S, Wong KYM, et al. Durable clinical benefit with nivolumab plus ipilimumab in DNA mismatch repair-deficient/microsatellite instability-high metastatic colorectal cancer[J]. J Clin Oncol, 2018, 36(8):773-779.
[21]
Feng K, Liu Y, Zhao Y, et al. Efficacy and biomarker analysis of nivolumab plus gemcitabine and cisplatin in patients with unresectable or metastatic biliary tract cancers: results from aphaseⅡstudy[J]. J Immunother Cancer, 2020, 8(1):e000367.
[22]
Zhang Q, Liu X, Wei S, et al. Lenvatinib plus PD-1 inhibitors as first-line treatment in patients with unresectable biliary tract cancer: a single-arm, open-label, phaseⅡstudy[J]. Front Oncol, 2021(11): 751391.
[23]
Cho Y, Kim TH, Seong J. Improved oncologic outcome with chemoradiotherapy followed by surgery in unresectable intrahepatic cholangiocarcinoma[J]. Strahlenther Onkol, 2017, 193(8):620-629.
[24]
Liu X, Yao J, Song L, et al. Local and abscopal responses in advanced intrahepatic cholangiocarcinoma with low TMB, MSS, pMMR and negative PD-L1 expression following combined therapy of SBRT with PD-1 blockade[J]. J Immunother Cancer, 2019, 7(1):204.
[25]
Liu ZL, Liu X, Peng H, et al. Anti-PD-1 immunotherapy and radiotherapy for stageⅣ intrahepatic cholangiocarcinoma: a case report[J]. Front Med, 2020(7):368.
[26]
Massani M, Bonariol L, Stecca T. Hepatic arterial infusion chemotherapy for unresectable intrahepatic cholangiocarcinoma, a comprehensive review[J]. J Clin Med, 2021, 10(12):2552.
[27]
Konstantinidis IT, Groot Koerkamp B, Do RK, et al. Unresectable intrahepatic cholangiocarcinoma: systemic plus hepatic arterial infusion chemotherapy is associated with longer survival in comparison with systemic chemotherapy alone[J]. Cancer, 2016, 122(5):758-765.
[28]
Mosconi C, Solaini L, Vara G, et al. Transarterial chemoembolization and radioembolization for unresectable intrahepatic cholangiocarcinoma-a systemic review and meta-analysis[J]. Cardiovasc Intervent Radiol, 2021, 44(5):728-738.
[29]
Rayar M, Sulpice L, Edeline J, et al. Intra-arterial yttrium-90 radioembolization combined with systemic chemotherapy is a promising method for downstaging unresectable huge intrahepatic cholangiocarcinoma to surgical treatment[J]. Ann Surg Oncol, 2015, 22(9):3102-3108.
[30]
Edeline J, Touchefeu Y, Guiu B, et al. Radioembolization plus chemotherapy for first-line treatment of locally advanced intrahepatic cholangiocarcinoma: a phase 2 clinical trial[J]. JAMA Oncol, 2020, 6(1):51-59.
[31]
Tustumi F, Ernani L, Coelho FF, et al. Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis[J]. HPB, 2018, 20(12):1109-1118.
[32]
Vauthey JN, Dixon E, Abdalla EK, et al. Pretreatment assessment of hepatocellular carcinoma: expert consensus statement[J]. HPB, 2010, 12(5):289-299.
[33]
Piron L, Deshayes E, Escal L, et al. Portal vein embolization: present and future[J]. Bull Cancer, 2017, 104(5):407-416.
[34]
Li PP, Huang G, Jia NY, et al. Associating liver partition and portal vein ligation for staged hepatectomy versus sequential transarterial chemoembolization and portal vein embolization in staged hepatectomy for HBV-related hepatocellular carcinoma: a randomized comparative study[J]. Hepatobiliary Surg Nutr, 2022, 11(1):38-51.
[35]
Li J, Moustafa M, Linecker M, et al. ALPPS for locally advanced intrahepatic cholangiocarcinoma: did aggressive surgery lead to the oncological benefit? an international multi-center study[J]. Ann Surg Oncol, 2020, 27(5):1372-1384.
[36]
Cheng AL, Qin S, Ikeda M, et al. Updated efficacy and safety data from IMbrave150: atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma[J]. J Hepatol, 2022, 76(4): 862-873.
[37]
Finn RS, Ikeda M, Zhu AX, et al. PhaseⅠb study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma[J]. J Clin Oncol, 2020, 38(26):2960-2970.
[38]
Job S, Rapoud D, Dos Santos A, et al. Identification of four immune subtypes characterized by distinct composition and functions of tumor microenvironment in intrahepatic cholangiocarcinoma[J]. Hepatology, 2020, 72(3):965-981.
[39]
Chaisaingmongkol J, Budhu A, Dang H, et al. Common molecular subtypes among Asian hepatocellular carcinoma and cholangiocarcinoma[J]. Cancer Cell, 2017, 32(1):57-70, e53.
[40]
Dong L, Lu D, Chen R, et al. Proteogenomic characterization identifies clinically relevant subgroups of intrahepatic cholangiocarcinoma[J]. Cancer Cell, 2022, 40(1):70-87, e15.
[41]
姜中豪, 戴朝六. 多学科综合治疗时代肝癌外科新理念[J/CD]. 中华普通外科学文献(电子版), 2020, 14(6):401-405.
[42]
Charriere B, Muscari F, Maulat C, et al. Outcomes of patients with hepatocellular carcinoma are determined in multidisciplinary team meetings[J]. J Surg Oncol, 2017, 115(3):330-336.
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