肝内胆管癌的综合治疗

肝内胆管癌(ICC)具有恶性程度高,发现晚,容易发生淋巴结转移、脉管侵润及肝内播散等特点,导致患者预后较差。根治性手术仍然是目前唯一可以使患者获得长期生存的治疗方式,但存在根治性切除率低、术后容易复发等诸多难题以及肝切除范围和切缘宽度确定、淋巴结清扫与否等诸多争议。辅助治疗是综合治疗的重要组成部分,但放化疗尚无规范、有效的方案,靶向治疗与免疫治疗正处于临床探索阶段。随着分子生物学技术的进展,发现ICC在基因突变、信号传导以及临床病理特征上展现出高度的异质性。笔者从ICC生物学特性及临床特点的异质性出发,结合ICC治疗策略和新的综合治疗理念,为其个体化治疗提供新的思路与研究方向。

Multimodality treatment of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is characterized by highly malignant behavior, being difficult to make an early detection, and frequent lymph node metastasis, vascular invasion and intrahepatic dissemination, which lead to the poor prognosis of the patients. At present, radical operation is still the only therapy for providing a chance of long-term survival, but it faces many problems such as low radical-resection rate and high postoperative recurrence rate, as well as many controversies such as determinations for the scope of liver resection and the width of the surgical margin and whether the lymph node dissection should be done. Adjuvant therapy is a critical component of the multimodality treatment, but there are no standard directions and effective protocols for its chemoradiotherapy, and the targeted therapy and immunotherapy are at the stage of exploration. With the development of molecular biological techniques, high degree of heterogeneity has been found in ICC in terms of gene mutation, signal transduction and clinicopathologic features. Here, the authors from the heterogeneity of the biological characteristics and clinical features of ICC in combination with the treatment strategies and the new concept of integrated therapy for ICC, provide new insights and research directions for its individualized treatment.