当前肝内胆管细胞癌诊疗热点分析

Current focus issues in diagnosis and treatment of intrahepatic cholangiocarcinoma

肝内胆管细胞癌(ICC)是高度恶性的肝脏肿瘤,侵袭性极强,预后极差。ICC起源于胆管,位于肝脏,既属于原发性肝癌,又可属于胆管癌,归类不明确,病理分型仍存在争议性。ICC高危因素众多,但诱导发生机制尚不明确。ICC早期症状常无特异性,也无特异性肿瘤标志物,诊断主要依赖于影像学检查,其中增强CT和MRI是最主要的评估方式。ICC的TNM分期对指导治疗具有重要意义,但AJCC第8版更新的T分期在划分上仍具有争议性。根治性手术仍是目前唯一可能治愈ICC的方式,但是关于R0切除定义以及淋巴结清扫范围仍存在较大争议。局部治疗的应用,以及免疫靶向治疗的迅猛发展,为局部进展期患者转化治疗带来了新的希望,其疗效仍需多中心、大样本临床研究验证。及时把握当前ICC诊疗热点,将是今后ICC基础和临床研究的重要方向。

Intrahepatic cholangiocarcinoma(ICC)is a highly malignant liver tumor with strong invasion and poor prognosis.ICC originates from the bile duct and locates in the liver,so it is classified as either primary liver cancer or cholangiocarcinoma,which the classification is indeterminate and the pathological typing is still debatable.The mechanism of ICC induced by many high-risk factors is still unclear.There are no characteristic manifestations in early symptom and no specific tumor markers,and the diagnosis of ICC mainly depends on imaging examination,which enhanced CT and MRI are the most important evaluation method.TNM staging of ICC is of great significance to guide the treatment,nevertheless,the division of T stage updated by AJCC 8th Edition is still controversial.Radical surgery is the only way to cure ICC currently,but there are still many controversies on definition of R0 resection and the scope of lymph node dissection.The application of local therapy and the rapid development of immunity and targeted therapy bring new hope for the transformation therapy of locally advanced patients,however,the efficacy needs to be verified by multi center large sample clinical studies.To grasp the current focus issues in diagnosis and treatment of ICC timely will be an important direction of basic and clinical research of ICC in the future.