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1、2023肝内胆管癌治疗进展：临床医生当前和未来治疗前景概述众所周知，史上影响因子最高的期刊是神刊：CA-CANCErJCLIN,期刊全称:CA-ACANCERJOURNALFORCLINICIANSo2020IF高达508.702,这一记录令无数期刊难望其项背。其高IF的原因，一方面在于发文量小，每年Article和Review几乎不超过30篇。另一方面就在于每年会发布各种重要的癌症统计数据(CancerStatistics),得到非常高的引用。摘要肝内胆管癌(ICO是第二常见的原发性肝脏肿瘤，在大多数患者中仍然是一种致死性恶性肿瘤。仅有20%-30%的患者可以接受潜在治愈的手术切除治疗，并且
2、，据文献报道，手术切除的患者使用卡培他滨辅助治疗，中位总生存期为53个月。对于70%-80%局部不可切除或远处转移性ICC的患者，系统治疗可能会延缓疾病进展，但生存期仍限于大约1年。在过去的十年中，吉西他滨和顺粕的双化疗方案被认为是最有效的一线治疗方案，但最近使用的免疫三联疗法可能会改变这种模式。与此同时，更有效的治疗策略，包括将全身治疗与局部治疗(如放射栓塞或肝动脉灌注)相结合的那治疗方案，也在临床开发中。分子靶向疗法,包括靶向成纤维细胞生长因子受侬FGFR也异柠檬酸脱氢酶(IDH)的分子靶向疗法，已通过美国FDA批准，作为高达40%的具有这些基因突变型患者的二线治疗方案，目前，正在研究是否
3、应将其纳入一线治疗。此外，最近的数据表明，度伐利尤单抗与标准化疗联合使用可提高ICC患者的生存率。这篇综述着重于IeC治疗的当前和未来策略。SurgeryHopaloctomy Iympbadenectomy adjuvant CbecnotbonapyEnIboIlZatIonTARE. TACRadiatiSYSTEMIC THERAPYCytotoxic chemotherapy(GenVCi6 ； Nab PoeaolCytotoxic chemotherapy * immunotherapy(G亦CiS DiMvaIumab)Targeted therapy(e.g. FGFR or
4、 DH irWbitoc)AblationEmbolization TARE. TACE HAIClinical trialTransplant图LICC的治疗策略局部胆管癌（定义为孤立的可切除肿瘤）的治疗包括切除术或肝脏导向的治疗。对于局部晚期或多病灶患者，建议采用多模式治疗方案，包括局部和全身治疗。对于系统性疾病，化疗士免疫和靶向是治疗的主要策略。图2.胆管癌的解剖位置胆管癌根据不同的解剖位置可分为：肝内胆管癌（iCC）、肝门部胆管癌（PCC）、远端胆管癌（dCC）。肝内胆管癌（iCC）位于肝实质内二级胆管附近。肝门周围胆管癌（pCC）位于二级胆管与胆囊管和肝总管交界处之间。远端胆管癌（d
5、CC）局限于胆总管，位于胆囊管插入物下方。HCCICCpre-contrast arterial phase portal venous delayed phase图3.HCC和ICC的影像学特征造影前、动脉、门静脉和延迟期HCC和ICC的经典多相对比增强磁共振成像示例如上图所示。HCC在动脉期表现为典型的均匀性血管过多，在门静脉期增强程度明显降低，低于正常肝实质（冲洗），在延迟期持续或更突出。HCC通常有一个包膜，它是一个薄的线性边缘，在所有阶段都持续增强。ICC在动脉期表现为典型的非均匀性血管过多，在门静脉期和延迟期表现为非均匀性、持续性增强，大于肝实质。ICC的治疗对于ICC的治疗，依然
6、已化疗方案为主。随着肿瘤基因测序技术的广泛应用，ICC的分子靶向治疗也得到迅速发展。而随着免疫检查点抑制剂在诸多实体肿瘤领域的研究进展，在ICC领域，也取得一定突破。由于篇幅所限，就该综述中的一些图表进行整理。Ifitrahepatic Cbobntiocarcinomalocal*KcgonlTargeted tberpyfChet*oenbHonAtboAdjuvant chenot MrapyReMCtIoH with LNdissectionCUN3 triabNoadjuvant ChemOtherapyIOCOretiOA terapeHccudc ar infusonVtcn C
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