Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially c...Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially curative treatment,yet only one-fifth of patients are eligible for resection at initial diagnosis[3].Threedimensional(3D)reconstruction technology provides precise preoperative visualization of complex hilar anatomy,significantly enhancing surgical planning and outcomes[4].Recent advances in 3D reconstruction technology have enhanced preoperative planning by providing precise anatomical mapping of tumor-vessel relationships and biliary variations[4,5].Therefore,this report describes a case of left iCCA successfully resected with biliary reconstruction guided by 3D visualization.展开更多
Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1]....Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.展开更多
The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the p...The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the prognosis for ICC remains poor.Owing to the high degree of malignancy and insidious onset of ICC,numerous cases are detected at intermediate or advanced stages of the disease,hence eliminating the chance for surgical intervention.Moreover,because of the highly invasive characteristics of ICC,recurrence and metastasis postresection are prevalent,leading to a 5-year survival rate of only 20%-35%following surgery.In the past decade,different methods of treatment have been investigated,including transarterial chemoembolization,transarterial radioembolization,radiotherapy,systemic therapy,and combination therapies.For certain patients with advanced ICC,conversion treatment may be utilized to facilitate surgical resection and manage disease progression.This review summarizes the definition of downstaging conversion treatment and presents the clinical experience and evidence concerning conversion treatment for advanced ICC.展开更多
BACKGROUND Cholangiocarcinoma(CCA),also known as bile duct cancer,is a devastating malignancy primarily affecting the biliary tract.AIM To assess their performance in clinical diagnosis and monitoring of CCA,plasma me...BACKGROUND Cholangiocarcinoma(CCA),also known as bile duct cancer,is a devastating malignancy primarily affecting the biliary tract.AIM To assess their performance in clinical diagnosis and monitoring of CCA,plasma methylation and circulating tumor cells were detected.METHODS Plasma samples were collected from Hubei Cancer Hospital(n=156).Plasma DNA was tested to detect SHOX2,HOXA9,SEPTIN9,and RASSF1A methylation using TaqMan PCR.Circulating tumor cells(CTCs)were detected in the peripheral blood of patients using the United States Food and Drug Administration-approved cell search system before and after clinical therapy.The CCA diagnostic value was estimated using the area under the curve.The independent prognosis risk factors for patients with CCA were estimated using Cox and logistic regression analyses.RESULTS The sensitivity and specificity of the four DNA plasma methylations exhibited 64.74%sensitivity and 93.88%specificity for detecting CCA.The receiver operating characteristic curve of the combined value for CCA diagnosis in plasma was 0.828±0.032.RASSF1A plasma methylation was related to the prognosis of patients with CCA.We determined the prognostic hazard ratio for CCA using CTC count,tumor stage,methylation,and carbohydrate antigen 19-9 levels as key factors.Our overall survival nomogram achieved a C-index of 0.705(0.605-0.805).CONCLUSION SHOX2,HOXA9,SEPTIN9,and RASSF1A plasma methylation demonstrated increased sensitivity for diagnosing CCA.RASSF1A plasma methylation and CTCs were valuable predictors to assess CCA prognosis and recurrence.展开更多
BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(D...BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.展开更多
BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperat...BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.展开更多
Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous malignancy arising from the epithelial cells of the biliary tract.The limitations of the current methods in the diagnosis of CCA highlight the urgent nee...Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous malignancy arising from the epithelial cells of the biliary tract.The limitations of the current methods in the diagnosis of CCA highlight the urgent need for new,accurate tools for early cancer detection,better prognostication and patient monitoring.Liquid biopsy(LB)is a modern and non-invasive technique comprising a diverse group of methodologies aiming to detect tumour biomarkers from body fluids.These biomarkers include circulating tumour cells,cell-free DNA,circulating tumour DNA,RNA and extracellular vesicles.The aim of this review is to explore the current and potential future applications of LB in CCA management,with a focus on diagnosis,prognostication and monitoring.We examine both its significant potential and the inevitable limitations associated with this technology.We conclude that LB holds considerable promise,but further research is necessary to fully integrate it into precision oncology for CCA.展开更多
Cholangiocarcinoma(CCA)is a rare type of cancer which arises from the bile duct epithelium and carries a poor prognosis.One of the main risk factors in the Western world is primary sclerosing cholangitis.Surgical rese...Cholangiocarcinoma(CCA)is a rare type of cancer which arises from the bile duct epithelium and carries a poor prognosis.One of the main risk factors in the Western world is primary sclerosing cholangitis.Surgical resection has traditionally been the only curative treatment but can only be offered to patients with early disease,excluding those with locally advanced disease.Despite initial poor outcomes,liver transplantation(LT)has evolved as a viable treatment for a select group of patients with CCAs that are deemed unresectable.This review aims to explore the evolution of the role of LT in patients with CCA.展开更多
Cholangiocarcinoma(CCA)is the second most common primary liver cancer worldwide,with a high mortality rate.Due to the lack of information regarding disease markers,characterization tools,and early detection methods,mo...Cholangiocarcinoma(CCA)is the second most common primary liver cancer worldwide,with a high mortality rate.Due to the lack of information regarding disease markers,characterization tools,and early detection methods,mortality continues to increase.The disease can be classified into two main groups:Intrahepatic CCA and extrahepatic CCA,the second of which is further subdi-vided into perihilar CCA and distal CCA.Certain regions are found to be at higher risk due to the presence of different contributing factors.These include hepatobiliary diseases,extrahepatic conditions,and environmental exposures.CCA shows a sex-related disparity,affecting men more than women,and its incidence rises progressively with age.These risk factors likely contribute to the rising incidence observed in certain regions,as each region is predominantly affected by distinct factors,resulting in wide geographical variations in CCA incidence.Epidemiological reports published before 2000 indicate a global increase in the incidence of intrahepatic CCA,whereas the incidence of extra-hepatic CCA is reportedly decreasing.The present study offers an important epidemiological perspective by analyzing the incidence trends of gallbladder malignancies over a 17-year period in Northeastern Italy,analyzed according to sex and age groups.展开更多
This article summarized the role of interleukins(ILs)in the pathogenesis of cholangiocarcinoma(CCA).It discovered a negative feedback mechanism wherein alternative splicing led to the upregulation of the IL 1 receptor...This article summarized the role of interleukins(ILs)in the pathogenesis of cholangiocarcinoma(CCA).It discovered a negative feedback mechanism wherein alternative splicing led to the upregulation of the IL 1 receptor antagonist(IL1RN)isoforms IL1RN-201 and IL1RN-203,which play a crucial anti-inflammatory role in KRAS-mutant intrahepatic CCA(iCCA).Higher levels of IL-4 receptor were associated with a worse survival rate in patients with CCA.In addition,elevated levels of serum IL-6 have been associated with the start and progression of CCA,a common cancer generated by inflammation.IL-8 was a useful predictor of human hilar CCA.Mechanistically,signal transducer and activator of transcription 3 signaling was used by IL-10 produced from M2-polarized tumor-associated macrophages to enhance the malignant characteristics of iCCA cells.It was suggested that IL-17A and IL-22 have an impact on the development of CCA associated with hepatic fluke infection.The most significant finding was the decreased expression of the IL-23 receptor,a prognostic gene,in iCCA.IL-25 may be a useful prognostic biomarker as aberrant expression of the protein in CCA tissue was linked to tumor spread and a poor prognosis.Tumor cell migration and proliferation were both accelerated by homogenized liver tissue that expressed IL-33 significantly.The correlation between high IL-35 expression and aggressiveness in iCCA highlights it as a useful biomarker for assessing the course and prognosis of iCCA in clinical settings.This article concluded that IL-1,IL-4,IL-6,IL-8,IL-10,IL-17,IL-23,IL-25,IL-33,and IL-35 play significant roles in the pathogenesis of CCA.Further research is required to find the association of other ILs such as IL-2,IL-3,IL-5,IL-7,IL-11,and more in the pathogenesis of CCA.展开更多
We read with great interest the study by Huang et al.Cholangiocarcinoma(CC)is the second most common type of primary liver tumor worldwide.Although surgical resection remains the primary treatment for this disease,alm...We read with great interest the study by Huang et al.Cholangiocarcinoma(CC)is the second most common type of primary liver tumor worldwide.Although surgical resection remains the primary treatment for this disease,almost 50%of patients experience relapse within 2 years after surgery,which negatively affects their prognosis.Key predictors can be used to identify several factors(e.g.,tumor size,tumor location,tumor stage,nerve invasion,the presence of intravascular emboli)and their correlations with long-term survival and the risk of postoperative morbidity.In recent years,artificial intelligence(AI)has become a new tool for prognostic assessment through the integration of multiple clinical,surgical,and imaging parameters.However,a crucial question has arisen:Are we ready to trust AI with respect to clinical decisions?The study by Huang et al demonstrated that AI can predict preoperative textbook outcomes in patients with CC and highlighted the precision of machine learning algorithms using useful prognostic factors.This letter to the editor aimed to explore the challenges and potential impact of AI and machine learning in the prognostic assessment of patients with CC.展开更多
Objective To develop and validate a preoperative clinical-radiomics model for predicting overall survival(OS)and disease-free survival(DFS)in patients with extrahepatic cholangiocarcinoma(eCCA)undergoing radical resec...Objective To develop and validate a preoperative clinical-radiomics model for predicting overall survival(OS)and disease-free survival(DFS)in patients with extrahepatic cholangiocarcinoma(eCCA)undergoing radical resection.Methods In this retrospective study,consecutive patients with pathologically-confirmed eCCA who underwent radical resection at our institution from 2015 to 2022 were included.The patients were divided into a training cohort and a validation cohort according to the chronological order of their CT examinations.Least absolute shrinkage and selection operator(LASSO)-Cox regression was employed to select predictive radiomic features and clinical variables.The selected features and variables were incorporated into a Cox regression model.Model performance for 1-year OS and DFS prediction was assessed using calibration curves,area under receiver operating characteristic curve(AUC),and concordance index(C-index).Results This study included 123 patients(mean age 64.0±8.4 years,85 males/38 females),with 86 in the training cohort and 37 in the validation cohort.The OS-predicting model included four clinical variables and four radiomic features.It achieved a training cohort AUC of 0.858(C-index=0.800)and a validation cohort AUC of 0.649(C-index=0.605).The DFS-predicting model included four clinical variables and four other radiomic features.It achieved a training cohort AUC of 0.830(C-index=0.760)and a validation cohort AUC of 0.717(C-index=0.616).Conclusion The preoperative clinical-radiomics models show promise as a tool for predicting 1-year OS and DFS in eCCA patients after radical surgery.展开更多
Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains...Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains unfavorable even after surgical resection.Therefore,neo-adjuvant therapy has emerged as a potential treatment option for patients with ICC.Neoadjuvant therapy can improve patient prognosis by reducing the tumor size and eliminating tiny lesions that are not visible to the naked eye.Nevertheless,specific treatment options for neoad-juvant therapy are unavailable.This review summarizes the studies on neoadjuvant therapy for ICC in the last decade,including chemotherapy,radiotherapy,interventional therapy,targeted therapy,and immunotherapy,with the aim of providing suggestions for the selection of clinical treatment options for patients with ICC.Current reports suggest that chemotherapy is the most effective neoadjuvant treatment option.How-ever,radiotherapy and interventional therapies require further investigation to obtain conclusive recommendations.Although targeted thera-pies and immunotherapies have been studied less extensively,several ongoing clinical trials are investigating these promising approaches.展开更多
In order to evaluate emerging imaging strategies for optimizing cholangiocarcinoma(CCA)assessment in liver transplantation(LT)candidates,addressing gaps in standardization,diagnostic ambiguity,and equitable access.Cri...In order to evaluate emerging imaging strategies for optimizing cholangiocarcinoma(CCA)assessment in liver transplantation(LT)candidates,addressing gaps in standardization,diagnostic ambiguity,and equitable access.Critical analysis of current evidence and innovations in CCA imaging,focusing on three pillars:(1)Adaptation of Liver Imaging Reporting and Data System for standardized reporting;(2)Integration of artificial intelligence(AI)-driven radiomics for risk stratification;and(3)Expanded utilization of contrast-enhanced ultrasound(CEUS)in resource-limited settings.Current imaging criteria for LT eligibility in CCA rely heavily on tumor size and vascular invasion,but lack standardized protocols for lesion characterization in cirrhotic livers.Liver Imaging Reporting and Data System,validated for hepatocellular carcinoma,shows promise in reducing interobserver variability when adapted to CCA-specific features(e.g.,targetoid appearance on magnetic resonance imaging).AI-driven radiomics can predict microvascular invasion and post-LT recurrence risk with 85%accuracy in preliminary studies,while CEUS demonstrates 92%specificity for differentiating intrahepatic CCA from dysplastic nodules in cirrhosis.A harmonized approach combining standardized reporting systems,AI-powered analytics,and accessible imaging modalities like CEUS could redefine LT pathways for CCA.Collaborative efforts between radiologists and transplant teams are essential to translate these innovations into equitable,precision-driven care.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(...BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(TACE)in cholangiocarcinoma and evaluate the efficacy and safety of combining it with gemcitabine and cisplatin(GemCis)for unresectable iCCA.METHODS Cholangiocarcinoma cell lines(RBE,HuCC-T1)were treated with 10 chemotherapeutic drugs,and cytotoxicity was assessed by cell counting kit-8 assays.Tumorbearing nude mice were treated with idarubicin or GemCis,and tumor growth was monitored.Clinical data from 85 iCCA patients were analyzed to evaluate the efficacy and safety of idarubicin-TACE combined with GemCis.RESULTS Idarubicin demonstrated the highest cytotoxicity,significantly outperforming GemCis,the standard first-line therapies.In tumor-bearing mouse models,idarubicin and GemCis treatments significantly slowed tumor growth,with idarubicin showing particularly pronounced effects on days 12 and 15(P<0.05).In retrospective analysis,the median overall survival(OS)and progression-free survival(PFS)in the combination therapy group were significantly longer than those in the GemCis alone group(median OS,16.23 months vs 10.07 months,P=0.042;median PFS,7.73 months vs 6.30 months,P=0.023).Additionally,major grade 3/4 adverse events(AEs)in the combination therapy group were abdominal pain(26.3%vs 6.5%,P=0.049)and elevated transaminases(42.1%vs 12.9%,P=0.038).Most AEs were mild to moderate and manageable.CONCLUSION Idarubicin demonstrated higher cytotoxicity than GemCis,significantly inhibiting tumor growth in tumor-bearing mouse models.Preliminary clinical results suggest that local idarubicin-TACE combined with GemCis may offer improved survival outcomes for iCCA patients with a manageable safety profile.展开更多
BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influen...BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.展开更多
基金supported by grants from the National Natural Science Foundation of China(82170412)Shanghai Municipal Science and Technology Commission Clinical Innovation Research Special Project(23Y11905400).
文摘Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially curative treatment,yet only one-fifth of patients are eligible for resection at initial diagnosis[3].Threedimensional(3D)reconstruction technology provides precise preoperative visualization of complex hilar anatomy,significantly enhancing surgical planning and outcomes[4].Recent advances in 3D reconstruction technology have enhanced preoperative planning by providing precise anatomical mapping of tumor-vessel relationships and biliary variations[4,5].Therefore,this report describes a case of left iCCA successfully resected with biliary reconstruction guided by 3D visualization.
文摘Based on the Bismuth-Corlette classification of hilar cholangiocarcinoma,the patients with types I,II,and III can undergo radical resection in the absence of extensive intrahepatic metastasis and vascular invasion[1].Depending on the scope of tumor invasion in bile duct,a combined resection of parts of the liver,hepatic ducts,common bile ducts,regional lymph nodes,and even parts of the duodenum and pancreas is necessary,along with biliary and gastrointestinal reconstructions[2].The surgical plan is complex,involving a large resection area and significant trauma.In recent years,laparoscopic or robot assisted radical resection of hilar cholangiocarcinoma has been applied clinically[3,4].With the advanced laparoscopic equipment,many patients undergo hepatopancreatoduodenectomy successfully[5].The limitations of traditional laparoscopic techniques restrict their wide application in clinical practice.However,the Da Vinci robot has been widely applied due to its clear field of vision and flexible manipulation.However,its utilization in hepato-pancreatoduodenectomy for hilar cholangiocarcinoma is still relatively rare.Here,we report a case with hilar cholangiocarcinoma at clinical stage IIIb who underwent robot-assisted hepato-pancreatoduodenectomy.
文摘The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the prognosis for ICC remains poor.Owing to the high degree of malignancy and insidious onset of ICC,numerous cases are detected at intermediate or advanced stages of the disease,hence eliminating the chance for surgical intervention.Moreover,because of the highly invasive characteristics of ICC,recurrence and metastasis postresection are prevalent,leading to a 5-year survival rate of only 20%-35%following surgery.In the past decade,different methods of treatment have been investigated,including transarterial chemoembolization,transarterial radioembolization,radiotherapy,systemic therapy,and combination therapies.For certain patients with advanced ICC,conversion treatment may be utilized to facilitate surgical resection and manage disease progression.This review summarizes the definition of downstaging conversion treatment and presents the clinical experience and evidence concerning conversion treatment for advanced ICC.
基金Supported by the Medical Talents of Wuhan Health and Family Planning Commission,No.2017[51](to Yu J)the Medical Talents of Wuhan Hospital of Traditional Chinese and Western Medicine(to Yu J)+1 种基金the Hubei Natural Science Foundation,No.2023AFB1091Wuhan Medical Research Project,No.WX23A36(to Yu J).
文摘BACKGROUND Cholangiocarcinoma(CCA),also known as bile duct cancer,is a devastating malignancy primarily affecting the biliary tract.AIM To assess their performance in clinical diagnosis and monitoring of CCA,plasma methylation and circulating tumor cells were detected.METHODS Plasma samples were collected from Hubei Cancer Hospital(n=156).Plasma DNA was tested to detect SHOX2,HOXA9,SEPTIN9,and RASSF1A methylation using TaqMan PCR.Circulating tumor cells(CTCs)were detected in the peripheral blood of patients using the United States Food and Drug Administration-approved cell search system before and after clinical therapy.The CCA diagnostic value was estimated using the area under the curve.The independent prognosis risk factors for patients with CCA were estimated using Cox and logistic regression analyses.RESULTS The sensitivity and specificity of the four DNA plasma methylations exhibited 64.74%sensitivity and 93.88%specificity for detecting CCA.The receiver operating characteristic curve of the combined value for CCA diagnosis in plasma was 0.828±0.032.RASSF1A plasma methylation was related to the prognosis of patients with CCA.We determined the prognostic hazard ratio for CCA using CTC count,tumor stage,methylation,and carbohydrate antigen 19-9 levels as key factors.Our overall survival nomogram achieved a C-index of 0.705(0.605-0.805).CONCLUSION SHOX2,HOXA9,SEPTIN9,and RASSF1A plasma methylation demonstrated increased sensitivity for diagnosing CCA.RASSF1A plasma methylation and CTCs were valuable predictors to assess CCA prognosis and recurrence.
文摘BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.
基金Supported by National Key Research and Development Program,No.2022YFC2407304Major Research Project for Middle-Aged and Young Scientists of Fujian Provincial Health Commission,No.2021ZQNZD013+2 种基金The National Natural Science Foundation of China,No.62275050Fujian Province Science and Technology Innovation Joint Fund Project,No.2019Y9108Major Science and Technology Projects of Fujian Province,No.2021YZ036017.
文摘BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.
文摘Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous malignancy arising from the epithelial cells of the biliary tract.The limitations of the current methods in the diagnosis of CCA highlight the urgent need for new,accurate tools for early cancer detection,better prognostication and patient monitoring.Liquid biopsy(LB)is a modern and non-invasive technique comprising a diverse group of methodologies aiming to detect tumour biomarkers from body fluids.These biomarkers include circulating tumour cells,cell-free DNA,circulating tumour DNA,RNA and extracellular vesicles.The aim of this review is to explore the current and potential future applications of LB in CCA management,with a focus on diagnosis,prognostication and monitoring.We examine both its significant potential and the inevitable limitations associated with this technology.We conclude that LB holds considerable promise,but further research is necessary to fully integrate it into precision oncology for CCA.
文摘Cholangiocarcinoma(CCA)is a rare type of cancer which arises from the bile duct epithelium and carries a poor prognosis.One of the main risk factors in the Western world is primary sclerosing cholangitis.Surgical resection has traditionally been the only curative treatment but can only be offered to patients with early disease,excluding those with locally advanced disease.Despite initial poor outcomes,liver transplantation(LT)has evolved as a viable treatment for a select group of patients with CCAs that are deemed unresectable.This review aims to explore the evolution of the role of LT in patients with CCA.
文摘Cholangiocarcinoma(CCA)is the second most common primary liver cancer worldwide,with a high mortality rate.Due to the lack of information regarding disease markers,characterization tools,and early detection methods,mortality continues to increase.The disease can be classified into two main groups:Intrahepatic CCA and extrahepatic CCA,the second of which is further subdi-vided into perihilar CCA and distal CCA.Certain regions are found to be at higher risk due to the presence of different contributing factors.These include hepatobiliary diseases,extrahepatic conditions,and environmental exposures.CCA shows a sex-related disparity,affecting men more than women,and its incidence rises progressively with age.These risk factors likely contribute to the rising incidence observed in certain regions,as each region is predominantly affected by distinct factors,resulting in wide geographical variations in CCA incidence.Epidemiological reports published before 2000 indicate a global increase in the incidence of intrahepatic CCA,whereas the incidence of extra-hepatic CCA is reportedly decreasing.The present study offers an important epidemiological perspective by analyzing the incidence trends of gallbladder malignancies over a 17-year period in Northeastern Italy,analyzed according to sex and age groups.
文摘This article summarized the role of interleukins(ILs)in the pathogenesis of cholangiocarcinoma(CCA).It discovered a negative feedback mechanism wherein alternative splicing led to the upregulation of the IL 1 receptor antagonist(IL1RN)isoforms IL1RN-201 and IL1RN-203,which play a crucial anti-inflammatory role in KRAS-mutant intrahepatic CCA(iCCA).Higher levels of IL-4 receptor were associated with a worse survival rate in patients with CCA.In addition,elevated levels of serum IL-6 have been associated with the start and progression of CCA,a common cancer generated by inflammation.IL-8 was a useful predictor of human hilar CCA.Mechanistically,signal transducer and activator of transcription 3 signaling was used by IL-10 produced from M2-polarized tumor-associated macrophages to enhance the malignant characteristics of iCCA cells.It was suggested that IL-17A and IL-22 have an impact on the development of CCA associated with hepatic fluke infection.The most significant finding was the decreased expression of the IL-23 receptor,a prognostic gene,in iCCA.IL-25 may be a useful prognostic biomarker as aberrant expression of the protein in CCA tissue was linked to tumor spread and a poor prognosis.Tumor cell migration and proliferation were both accelerated by homogenized liver tissue that expressed IL-33 significantly.The correlation between high IL-35 expression and aggressiveness in iCCA highlights it as a useful biomarker for assessing the course and prognosis of iCCA in clinical settings.This article concluded that IL-1,IL-4,IL-6,IL-8,IL-10,IL-17,IL-23,IL-25,IL-33,and IL-35 play significant roles in the pathogenesis of CCA.Further research is required to find the association of other ILs such as IL-2,IL-3,IL-5,IL-7,IL-11,and more in the pathogenesis of CCA.
文摘We read with great interest the study by Huang et al.Cholangiocarcinoma(CC)is the second most common type of primary liver tumor worldwide.Although surgical resection remains the primary treatment for this disease,almost 50%of patients experience relapse within 2 years after surgery,which negatively affects their prognosis.Key predictors can be used to identify several factors(e.g.,tumor size,tumor location,tumor stage,nerve invasion,the presence of intravascular emboli)and their correlations with long-term survival and the risk of postoperative morbidity.In recent years,artificial intelligence(AI)has become a new tool for prognostic assessment through the integration of multiple clinical,surgical,and imaging parameters.However,a crucial question has arisen:Are we ready to trust AI with respect to clinical decisions?The study by Huang et al demonstrated that AI can predict preoperative textbook outcomes in patients with CC and highlighted the precision of machine learning algorithms using useful prognostic factors.This letter to the editor aimed to explore the challenges and potential impact of AI and machine learning in the prognostic assessment of patients with CC.
文摘Objective To develop and validate a preoperative clinical-radiomics model for predicting overall survival(OS)and disease-free survival(DFS)in patients with extrahepatic cholangiocarcinoma(eCCA)undergoing radical resection.Methods In this retrospective study,consecutive patients with pathologically-confirmed eCCA who underwent radical resection at our institution from 2015 to 2022 were included.The patients were divided into a training cohort and a validation cohort according to the chronological order of their CT examinations.Least absolute shrinkage and selection operator(LASSO)-Cox regression was employed to select predictive radiomic features and clinical variables.The selected features and variables were incorporated into a Cox regression model.Model performance for 1-year OS and DFS prediction was assessed using calibration curves,area under receiver operating characteristic curve(AUC),and concordance index(C-index).Results This study included 123 patients(mean age 64.0±8.4 years,85 males/38 females),with 86 in the training cohort and 37 in the validation cohort.The OS-predicting model included four clinical variables and four radiomic features.It achieved a training cohort AUC of 0.858(C-index=0.800)and a validation cohort AUC of 0.649(C-index=0.605).The DFS-predicting model included four clinical variables and four other radiomic features.It achieved a training cohort AUC of 0.830(C-index=0.760)and a validation cohort AUC of 0.717(C-index=0.616).Conclusion The preoperative clinical-radiomics models show promise as a tool for predicting 1-year OS and DFS in eCCA patients after radical surgery.
基金supported by the National Natural Science Foundation of China(grants 82373365 and 82173317)the Tianjin Key Medical Discipline Construction Project(TJYXZDXK-009A).
文摘Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains unfavorable even after surgical resection.Therefore,neo-adjuvant therapy has emerged as a potential treatment option for patients with ICC.Neoadjuvant therapy can improve patient prognosis by reducing the tumor size and eliminating tiny lesions that are not visible to the naked eye.Nevertheless,specific treatment options for neoad-juvant therapy are unavailable.This review summarizes the studies on neoadjuvant therapy for ICC in the last decade,including chemotherapy,radiotherapy,interventional therapy,targeted therapy,and immunotherapy,with the aim of providing suggestions for the selection of clinical treatment options for patients with ICC.Current reports suggest that chemotherapy is the most effective neoadjuvant treatment option.How-ever,radiotherapy and interventional therapies require further investigation to obtain conclusive recommendations.Although targeted thera-pies and immunotherapies have been studied less extensively,several ongoing clinical trials are investigating these promising approaches.
文摘In order to evaluate emerging imaging strategies for optimizing cholangiocarcinoma(CCA)assessment in liver transplantation(LT)candidates,addressing gaps in standardization,diagnostic ambiguity,and equitable access.Critical analysis of current evidence and innovations in CCA imaging,focusing on three pillars:(1)Adaptation of Liver Imaging Reporting and Data System for standardized reporting;(2)Integration of artificial intelligence(AI)-driven radiomics for risk stratification;and(3)Expanded utilization of contrast-enhanced ultrasound(CEUS)in resource-limited settings.Current imaging criteria for LT eligibility in CCA rely heavily on tumor size and vascular invasion,but lack standardized protocols for lesion characterization in cirrhotic livers.Liver Imaging Reporting and Data System,validated for hepatocellular carcinoma,shows promise in reducing interobserver variability when adapted to CCA-specific features(e.g.,targetoid appearance on magnetic resonance imaging).AI-driven radiomics can predict microvascular invasion and post-LT recurrence risk with 85%accuracy in preliminary studies,while CEUS demonstrates 92%specificity for differentiating intrahepatic CCA from dysplastic nodules in cirrhosis.A harmonized approach combining standardized reporting systems,AI-powered analytics,and accessible imaging modalities like CEUS could redefine LT pathways for CCA.Collaborative efforts between radiologists and transplant teams are essential to translate these innovations into equitable,precision-driven care.
基金Supported by the Guangzhou Science and Technology Plan Project,No.2023A04J0419National Natural Science Foundation Cultivation Project at the Third Affiliated Hospital of Sun Yat-sen University,No.2022GZRPYQN04.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(TACE)in cholangiocarcinoma and evaluate the efficacy and safety of combining it with gemcitabine and cisplatin(GemCis)for unresectable iCCA.METHODS Cholangiocarcinoma cell lines(RBE,HuCC-T1)were treated with 10 chemotherapeutic drugs,and cytotoxicity was assessed by cell counting kit-8 assays.Tumorbearing nude mice were treated with idarubicin or GemCis,and tumor growth was monitored.Clinical data from 85 iCCA patients were analyzed to evaluate the efficacy and safety of idarubicin-TACE combined with GemCis.RESULTS Idarubicin demonstrated the highest cytotoxicity,significantly outperforming GemCis,the standard first-line therapies.In tumor-bearing mouse models,idarubicin and GemCis treatments significantly slowed tumor growth,with idarubicin showing particularly pronounced effects on days 12 and 15(P<0.05).In retrospective analysis,the median overall survival(OS)and progression-free survival(PFS)in the combination therapy group were significantly longer than those in the GemCis alone group(median OS,16.23 months vs 10.07 months,P=0.042;median PFS,7.73 months vs 6.30 months,P=0.023).Additionally,major grade 3/4 adverse events(AEs)in the combination therapy group were abdominal pain(26.3%vs 6.5%,P=0.049)and elevated transaminases(42.1%vs 12.9%,P=0.038).Most AEs were mild to moderate and manageable.CONCLUSION Idarubicin demonstrated higher cytotoxicity than GemCis,significantly inhibiting tumor growth in tumor-bearing mouse models.Preliminary clinical results suggest that local idarubicin-TACE combined with GemCis may offer improved survival outcomes for iCCA patients with a manageable safety profile.
基金Supported by National Research Foundation of Korea Grant Funded by the Korea Government,No.RS-2023-00213951.
文摘BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.
