Kodali Sudha, Connor Ashton A, Thabet Souhail, Brombosz Elizabeth W, Ghobrial R Mark
Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA; JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX 77030, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX 77030, USA; JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX 77030, USA; Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA; Department of Surgery, Weill Cornell Medical College, New York, NY, USA.
Hepatobiliary Pancreat Dis Int. 2024 Apr;23(2):129-138. doi: 10.1016/j.hbpd.2023.07.007. Epub 2023 Jul 23.
Intrahepatic cholangiocarcinoma (iCCA) is a rare biliary tract cancer with high mortality rate. Complete resection of the iCCA lesion is the first choice of treatment, with good prognosis after margin-negative resection. Unfortunately, only 12%-40% of patients are eligible for resection at presentation due to cirrhosis, portal hypertension, or large tumor size. Liver transplantation (LT) offers margin-negative iCCA extirpation for patients with unresectable tumors. Initially, iCCA was a contraindication for LT until size-based selection criteria were introduced to identify patients with satisfied post-LT outcomes. Recent studies have shown that tumor biology-based selection can yield high post-LT survival in patients with locally advanced iCCA. Another selection criterion is the tumor response to neoadjuvant therapy. Patients with response to neoadjuvant therapy have better outcomes after LT compared with those without tumor response to neoadjuvant therapy. Another index that helps predict the treatment outcome is the biomarker. Improved survival outcomes have also opened the door for living donor LT for iCCA. Patients undergoing LT for iCCA now have statistically similar survival rates as patients undergoing resection. The combination of surgery and locoregional and systemic therapies improves the prognosis of iCCA patients.
肝内胆管癌（iCCA）是一种死亡率较高的罕见胆道癌。完整切除iCCA病灶是首选治疗方法，切缘阴性切除后预后良好。不幸的是，由于肝硬化、门静脉高压或肿瘤体积较大，只有12% - 40%的患者在初诊时适合切除。肝移植（LT）为无法切除肿瘤的患者提供了切缘阴性的iCCA切除方法。最初，iCCA是LT的禁忌证，直到引入基于大小的选择标准以确定LT后预后良好的患者。最近的研究表明，基于肿瘤生物学的选择可以使局部晚期iCCA患者LT后获得较高的生存率。另一个选择标准是肿瘤对新辅助治疗的反应。与对新辅助治疗无肿瘤反应的患者相比，对新辅助治疗有反应的患者LT后预后更好。另一个有助于预测治疗结果的指标是生物标志物。生存结果的改善也为iCCA的活体供肝LT打开了大门。目前，接受iCCA LT的患者与接受切除术的患者的生存率在统计学上相似。手术与局部和全身治疗相结合可改善iCCA患者的预后。
