肝内胆管癌的分型及综合治疗现状

Current status of classification and comprehensive treatments for intrahepatic cholangiocarcinoma

肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)是一种恶性程度较高的原发性肝癌,其发病率处于原发性肝癌的第2位,手术切除是目前唯一可能治愈ICC的治疗方式。由于ICC侵袭性强、预后差,大部分病人发现疾病时已经失去手术机会,且手术后仍有较高的复发风险。近年来,经动脉化疗栓塞、肝动脉灌注化疗、放疗等多种治疗方式均取得了不同程度的进展,在ICC治疗领域显示出良好的临床效果,肝移植也逐渐在ICC早期病人中进行了积极的探索与尝试。目前,靶向治疗、免疫治疗等新的治疗方式也逐渐崭露头角。形成了以手术治疗为基石,多种治疗方式相结合的综合个性化的治疗体系。同时,随着基因测序技术的进展和肿瘤微环境等研究的深入,分子分型也成为近年来的热点,对靶向治疗等治疗方案的选择具有重要的意义。然而,目前仍有部分治疗方式存在争议,需要大规模的临床研究进行验证,从而提高治疗水平,改善病人的预后。此文就目前ICC的分子分型、局部治疗、系统治疗的新进展及分子分型对于靶向治疗等的指导作用进行总结与阐述。

Intrahepatic cholangiocarcinoma(ICC)is a highly malignant primary liver cancer with the second highest incidence of primary liver cancer.Surgical resection remains a sole cure for ICC.And due to great invasiveness,its prognosis remains poor.Most patients have lost the chance of surgery when the disease is initially detected.And there is still a high risk of postoperative recurrence.In recent years,transarterial chemoembolization,hepatic arterial infusion and chemoradiotherapy have achieved some successes of ICC treatment.Liver transplantation has gradually been actively explored for earlystage ICC.Currently targeted therapy and immunotherapy are also gradually emerging.Comprehensive and personalized treatments have been formulated with surgery as a mainstay along with a combination of various treatments.With rapid advancements of gene sequencing technology and in-depth researches on tumor microenvironment,molecular classification has also become a recent hotspot.However,some controversial protocols should be validated by large-scale clinical trials.This review summarized the latest advances of molecular classification,local/systemic treatment of ICC and guiding role of molecular classification for targeted therapy and other therapeutics.