Omoto Mayu, Sugimoto Katsutoshi, Kurebayashi Yutaka, Kakegawa Tatsuya, Takahashi Hiroshi, Wada Takuya, Takeuchi Hirohito, Nagao Toshitaka, Nagakawa Yuichi, Itoi Takao
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023, Japan.
Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
Clin J Gastroenterol. 2025 Jun;18(3):506-513. doi: 10.1007/s12328-025-02113-2. Epub 2025 Mar 28.
A 61-year-old female patient with advanced intrahepatic cholangiocarcinoma diagnosed based on imaging and tumor biopsy findings was treated with combination therapy comprising gemcitabine, cisplatin, and durvalumab. After eight cycles of therapy comprising gemcitabine, cisplatin, and durvalumab and two subsequent cycles of maintenance immunotherapy, significant tumor shrinkage enabled conversion surgery with R0 resection. The tumor immune microenvironment has a critical role in predicting the efficacy of combined immunotherapy in some types of cancer; however, its role in advanced intrahepatic cholangiocarcinoma remains largely unclear. In the current case, the tumor exhibited increased infiltration of CD8 T cells before treatment, and significant increase in CD8 T-cell infiltration, decrease in Treg/CD8 ratio, and development of tertiary lymphoid structures were observed after treatment. Pretreatment tumor immune microenvironment analyses may predict treatment outcomes and optimize strategies for advanced intrahepatic cholangiocarcinoma. Therapy comprising gemcitabine, cisplatin, and durvalumab and immune-based approaches may enhance personalized medicine for patients with advanced intrahepatic cholangiocarcinoma.
一名61岁的女性患者，根据影像学和肿瘤活检结果被诊断为晚期肝内胆管癌，接受了吉西他滨、顺铂和度伐利尤单抗的联合治疗。在进行了八个周期的吉西他滨、顺铂和度伐利尤单抗治疗以及随后两个周期的维持免疫治疗后，肿瘤显著缩小，从而能够进行R0切除的转化手术。肿瘤免疫微环境在预测某些类型癌症联合免疫治疗的疗效方面具有关键作用；然而，其在晚期肝内胆管癌中的作用仍 largely 不清楚。在当前病例中，治疗前肿瘤显示CD8 T细胞浸润增加，治疗后观察到CD8 T细胞浸润显著增加、Treg/CD8比值降低以及三级淋巴结构形成。治疗前肿瘤免疫微环境分析可能预测晚期肝内胆管癌的治疗结果并优化治疗策略。吉西他滨、顺铂和度伐利尤单抗的治疗以及基于免疫的方法可能会增强晚期肝内胆管癌患者的个性化医疗。
