Multi-Organ Transplant ProgramUniversity Health Network TorontoTorontoOntarioCanada.
Department of SurgeryHenry Ford HospitalDetroitMichiganUSA.
Hepatology. 2022 Feb;75(2):455-472. doi: 10.1002/hep.32258. Epub 2022 Jan 6.
Cholangiocarcinoma (CCA) represents the second-most common primary liver malignancy after HCC and has risen in incidence globally in the past decades. Intrahepatic cholangiocarcinoma (iCCA) comprises 20% of all CCAs, with the rest being extrahepatic (including perihilar [pCCA] and distal CCA). Though long representing an absolute contraindication for liver transplantation (LT), recent analyses of outcomes of LT for iCCA have suggested that iCCA may be a potentially feasible option for highly selected patients. This has been motivated both by successes noted in outcomes of LT for other malignancies, such as HCC and pCCA, and by several retrospective reviews demonstrating favorable results with LT for a selected group of iCCA patients with small lesions. LT for iCCA is primarily relevant within two clinical scenarios. The first includes patients with very early disease (single tumor, ≤2 cm) with cirrhosis and are not candidates for liver resection (LR). The second scenario is patients with locally advanced iCCA, but where the extent of LR would be too extensive to be feasible. Preliminary single-center reports have described LT in a selected group of patients with locally advanced tumors who have responded to neoadjuvant therapy and have a period of disease stability. Currently, there are three prospective trials underway that will help clarify the role of LT in iCCA. This review seeks to explore the available studies involving LT for iCCA, the challenges of ongoing trials, and opportunities for the future.
胆管癌（CCA）是继 HCC 之后第二大常见的原发性肝脏恶性肿瘤，在过去几十年中全球发病率有所上升。肝内胆管癌（iCCA）占所有 CCA 的 20%，其余为肝外胆管癌（包括肝门部胆管癌[pCCA]和远端胆管癌）。尽管长期以来一直是肝移植（LT）的绝对禁忌证，但最近对 iCCA 进行 LT 治疗的结果分析表明，iCCA 可能是高度选择的患者的潜在可行选择。这既是由于 HCC 和 pCCA 等其他恶性肿瘤 LT 结果的成功所推动，也是由于几项回顾性研究表明，对于一小部分 iCCA 患者，LT 治疗具有有利的结果，这些患者的肿瘤较小。iCCA 的 LT 主要与两种临床情况有关。第一种情况包括患有非常早期疾病（单个肿瘤，≤2 厘米）且伴有肝硬化的患者，这些患者不适合行肝切除术（LR）。第二种情况是局部晚期 iCCA 患者，但 LR 的范围太广而无法实施。初步的单中心报告描述了在一组对新辅助治疗有反应且疾病稳定期的局部晚期肿瘤患者中进行 LT。目前，有三项正在进行的前瞻性试验将有助于阐明 LT 在 iCCA 中的作用。本文旨在探讨涉及 iCCA 的 LT 的现有研究、正在进行的试验的挑战以及未来的机会。
