肝内胆管癌新辅助及转化治疗进展与争议

Advancements and controversies in neoadjuvant and conversion therapies for intrahepatic cholangiocarcinoma

摘要:

肝内胆管癌（ICC）起病隐匿，多数患者在初诊时已进展至中晚期阶段，错失根治性手术机会。外科治疗是ICC治疗的主要手段，但ICC术后早期复发率高，预后差。近年来，化学治疗、免疫治疗、靶向治疗等系统治疗及放射治疗、肝动脉灌注化疗、经导管动脉化学栓塞等局部治疗在ICC中不断取得突破性进展，ICC已进入系统治疗新时代。随着治疗效果的改善，转化治疗和新辅助治疗逐渐成为热点话题。然而，随着临床诊疗实践的深入，一系列错综复杂且悬而未决的问题逐渐浮出水面，引发了国内外学者的广泛探讨，目前美国国立综合癌症网络、中国临床肿瘤学会指南尚未形成明确的转化治疗和新辅助治疗规范化诊疗流程。本文旨在全面综述ICC新辅助及转化治疗的最新进展，深入探讨其中存在的争议焦点，以期为临床实践提供有益的参考，推动该领域的进一步发展。

Abstract:

Intrahepatic cholangiocarcinoma (ICC) typically has an insidious onset, and most patients have already progressed to advanced stages by the time of initial diagnosis, missing the opportunity for radical surgery. Surgical treatment is the main approach for ICC, but the high early recurrence rate after surgery and poor prognosis remain significant challenges. In recent years, there have been continuous breakthroughs in chemotherapy, immunotherapy, targeted therapy, and combination therapies for ICC, ushering in a new era for systemic treatment. With the improvement of treatment effects, conversion therapy, and neoadjuvant therapy have emerged as prominent topics of interest. However, with the deepening of clinical diagnosis and treatment practices, complex and unresolved issues have gradually emerged, triggering extensive discussions among scholars at home and abroad. Currently, there is no clear, standardized diagnostic and therapeutic process for conversion therapy and neoadjuvant therapy in the guidelines of the National Comprehensive Cancer Network or the Chinese Society of Clinical Oncology. This article aims to comprehensively review the latest progress in neoadjuvant and conversion therapy for ICC and deeply explore the controversial focuses therein, with the expectation of providing useful references for clinical practice and promoting the further development of this field.