Connor Ashton A, Kodali Sudha, Abdelrahim Maen, Javle Milind M, Brombosz Elizabeth W, Ghobrial R Mark
Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States.
Department of Surgery, Houston Methodist Hospital, Houston, TX, United States.
Front Oncol. 2022 Nov 21;12:996710. doi: 10.3389/fonc.2022.996710. eCollection 2022.
Intrahepatic cholangiocarcinoma (iCCA) is a primary epithelial cell malignancy of the liver with rising incidence rate globally. Its insidious presentation, heterogeneous and aggressive biology, and recalcitrance to current therapies results in unacceptably high morbidity and mortality. This has spurred research efforts in the last decade to better characterize it molecularly with translation to improved diagnostic tools and treatments. Much of this has been driven by patient advocacy. This has renewed interest in orthotopic liver transplantation (LT) with adjunctive therapies for iCCA, which was historically disparaged due to poor recipient outcomes and donor organ scarcity. However, the optimal use of LT as a treatment for iCCA care remains unclear. Here, we review the epidemiology of iCCA, the history of LT as a treatment modality, alternative approaches to iCCA local control, the evidence for peri-operative systemic therapies, and the potential roles of biomarkers and targeted agents. In doing so, we hope to prioritize areas for continued research and identify areas where multidisciplinary care can improve outcomes.
肝内胆管癌（iCCA）是一种肝脏原发性上皮细胞恶性肿瘤，全球发病率呈上升趋势。其隐匿的表现、异质性和侵袭性生物学行为以及对当前治疗的耐药性导致了高得令人无法接受的发病率和死亡率。这在过去十年中推动了研究工作，以更好地从分子层面表征它，并转化为改进的诊断工具和治疗方法。其中很大一部分是由患者倡导推动的。这重新激发了人们对原位肝移植（LT）联合辅助治疗iCCA的兴趣，由于受者预后不佳和供体器官稀缺，原位肝移植在历史上曾受到轻视。然而，LT作为iCCA治疗方法的最佳使用仍不明确。在此，我们回顾iCCA的流行病学、作为一种治疗方式的LT的历史、iCCA局部控制的替代方法、围手术期全身治疗的证据以及生物标志物和靶向药物的潜在作用。通过这样做，我们希望确定继续研究的重点领域，并确定多学科护理可以改善预后的领域。
