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[胆管癌的当前研究与证据]

[Current Studies and Evidence in Cholangiocarcinoma].

作者信息

Zimpel Carolin, Mitzlaff Katharina, Jasper Nina-Alexandra, Marquardt Jens U

机构信息

Medizinische Klinik I, UKSH Campus Lübeck, Lübeck, Deutschland.

出版信息

Zentralbl Chir. 2022 Aug;147(4):389-397. doi: 10.1055/a-1844-0267. Epub 2022 Jul 21.

Abstract

Cholangiocarcinoma (CCA) is the second most common type of primary liver cancer and includes a group of intra- and extrahepatic bile tract cancers. Prognosis of patients with CCA remains poor due to high recurrence rates after curative resections and often late diagnosis in advanced stages of the disease. Curative therapy is a complete resection that requires complex surgical procedures and potentially pre-operative induction of liver hypertrophy to ensure sufficient postoperative liver function. Adjuvant therapy with capecitabine for 6 months is well established in clinical routine. The therapeutic landscape for advanced stages is constantly progressing, due to new results of clinical phase II/III trials. On the one hand, molecular analyses have paved the way to effective targeted therapies for subgroups of CCA patients with alterations in FGFR2- or IDH1-signaling. On the other hand, immune-oncological approaches in combination with chemotherapy have resulted in safe and effective treatments for unselected patient cohorts. Further studies will investigate molecular-driven as well as immune-combination treatments in earlier stages of the disease and will result in new therapy options and better prognosis for CCA patients in the near future.

摘要

胆管癌(CCA)是第二常见的原发性肝癌类型,包括一组肝内和肝外胆管癌。由于根治性切除术后复发率高且疾病晚期往往诊断较晚,CCA患者的预后仍然很差。根治性治疗是完全切除,这需要复杂的外科手术,并且可能需要术前诱导肝肥大以确保足够的术后肝功能。在临床常规中,使用卡培他滨进行6个月的辅助治疗已得到充分确立。由于临床II/III期试验的新结果,晚期患者的治疗格局正在不断发展。一方面,分子分析为FGFR2或IDH1信号通路改变的CCA患者亚组的有效靶向治疗铺平了道路。另一方面,免疫肿瘤学方法与化疗相结合,为未选择的患者群体带来了安全有效的治疗方法。进一步的研究将在疾病的早期阶段研究分子驱动以及免疫联合治疗,并将在不久的将来为CCA患者带来新的治疗选择和更好的预后。

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