混合型肝细胞癌-胆管癌的临床诊治进展  

Research progress in clinical diagnosis and treatment strategies of combined hepatocellular-cholangiocarcinoma

作　　者：许祯滢 陈婷[1] 马佳曼 杨雨[1] XU Zhenying;CHEN Ting;MA Jiaman;YANG Yu(Department of Abdominal Oncology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院腹部肿瘤科,成都610041

出　　处：《中国普外基础与临床杂志》2022年第12期1667-1673,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结混合型肝细胞癌-胆管癌(combined hepatocellular-cholangiocarcinoma,cHCC-CCA)近年来的诊断及治疗进展,旨在为临床诊断和治疗决策提供参考。方法阅读并总结近年来与cHCC-CCA诊断与治疗相关研究的文献并进行综述。结果目前尚无特定针对cHCC-CCA诊断与治疗的相关指南或共识。cHCCCCA单纯依靠影像学检查结果诊断较为困难,肿瘤标志物如甲胎蛋白和糖类抗原19-9在临床诊断中具有一定价值,最终主要依靠病理检查结果。早期cHCC-CCA患者宜尽可能接受根治性手术,但关于采用肝移植治疗后的疗效、复发转移模式等存在一定争议;晚期cHCC-CCA患者的系统治疗还在进一步探索,一些小样本的回顾性分析认为吉西他滨及含铂方案的化学药物治疗或可获益。随着免疫治疗及靶向治疗在肝细胞癌和胆管癌中取得的较好效果,可能为cHCC-CCA的治疗选择提供经验借鉴。结论cHCC-CCA发病率较低、异质性较强,其诊断主要依赖于手术后的病理检查结果,但治疗策略仍缺乏高级别循证医学证据,未来仍需严谨设计的临床研究来探索其疗效及安全性。Objective To summarize the diagnosis and treatment progress of combined hepatocellularcholangiocarcinoma(cHCC-CCA)in recent years,in order to provide a reference for clinical diagnosis and treatment decision-making.Method The recent literature related to the diagnosis and treatment of cHCC-CCA was reviewed.Results There was no specific guideline or consensus on the diagnosis and management of cHCC-CCA.The diagnosis of the cHCC-CCA was challenging by imaging alone,and the tumor markers such as alpha fetoprotein and carbohydrate antigen 19-9 were of particular value in clinical diagnosis,but it was ultimately relied on the pathological examination results.For the patients with early cHCC-CCA,the radical surgery was recommended to undergo if possible,but there was some controversy regarding the efficacy of liver transplantation and the mode of recurrence and metastasis.For the patients with advanced cHCC-CCA,the systemic therapy was being explored further,and some retrospective analyses of small samples suggested that the gemcitabine and platinum-containing chemotherapy regimens might be beneficial.With the better success of immunotherapy and targeted therapies in hepatocellular carcinoma and cholangiocarcinoma,it might provide some experiences for treatment selection of cHCC-CCA.Conclusions cHCC-CCA has a lower incidence rate and stronger heterogeneity.Its diagnosis mainly relies on surgical pathology,and treatment strategy is lack of high-level evidence-based medical evidence and rigorously designed clinical studies are still needed to explore its efficacy and safety in the future.

关 键 词：混合型肝细胞癌-胆管癌 诊断 治疗 

分 类 号：R735.7[医药卫生—肿瘤] R735.8[医药卫生—临床医学]