中国普通外科杂志2025，Vol.34Issue(2)：260-271,12.DOI:10.7659/j.issn.1005-6947.250005
不可切除肝内胆管癌转化治疗进展与思考
Conversion therapy for unresectable intrahepatic cholangiocarcinoma:recent advances and prospects
摘要
Abstract
Intrahepatic cholangiocarcinoma(ICC)is a highly aggressive liver malignancy characterized by a subtle onset and rapid progression.Most patients are diagnosed at advanced stages,making radical surgical resection impossible,and the overall prognosis is poor.The ability to convert initially unresectable ICC to resectable tumors through multimodal comprehensive treatment is significant for prolonging patient survival.In recent years,with the application of immunotherapy and targeted therapy in advanced ICC,as well as improvements in surgical techniques,radiation therapy,hepatic arterial infusion chemotherapy,and selective internal radiation therapy,along with updates in treatment strategies and concepts,some initially unresectable ICC tumors have become resectable following downstaging with various treatment modalities,which has brought new hope for improving conversion resection success rates and patient prognosis.However,conversion therapy for ICC still faces numerous challenges and controversies,including the lack of a recognized standard treatment regimen,limited overall conversion success rates,a lack of long-term follow-up data to demonstrate survival benefits after conversion resection,and unresolved issues such as whether patients who achieve clinical complete remission should undergo resection or be monitored.Given that most current studies on ICC conversion therapy are small-sample,retrospective studies or case reports,lacking high-level evidence from randomized controlled trials,and the majority of studies include various types of biliary tract cancers without considering the heterogeneity across different anatomical locations,the relevance of these findings for guiding ICC conversion treatment strategies is limited.There is an urgent need for high-quality,multi-center,large-sample,prospective clinical studies and basic research to explore optimal ICC translational therapy regimens with rapid efficacy,high objective response rates,and good safety profiles,identify patient populations with potential benefits from different treatments,and develop individualized treatment strategies to improve conversion success rates and ultimately enhance patient prognosis.This article reviews the progress in the conversion treatment of unresectable ICC,intending to provide a reference for clinical practice.关键词
胆管肿瘤/胆管,肝内/转化治疗/免疫疗法/分子靶向治疗/抗肿瘤联合化疗方案Key words
Bile Duct Neoplasms/Bile Ducts,Intrahepatic/Conversion Therapy/Immunotherapy/Molecular Targeted Therapy/Antineoplastic Combined Chemotherapy Protocols分类
临床医学引用本文复制引用
苏天杭,雷正清,程张军..不可切除肝内胆管癌转化治疗进展与思考[J].中国普通外科杂志,2025,34(2):260-271,12.基金项目
国家自然科学基金资助项目(81871988) （81871988）
江苏省第六期"333工程"人才支持专项基金资助项目(CZXM-RC- 46) （CZXM-RC- 46）
江苏省卫生健康委医学科研重点基金资助项目(K2023010) （K2023010）
东南大学附属中大医院临床研究孵化基金资助项目(GSP-LCYJFH10). （GSP-LCYJFH10）
