胆管癌的分型、危险因素及其相关的治疗手段
Typing, Risk Factors and Related Treatments of Cholangiocarcinoma

DOI: 10.12677/ACM.2014.44014, PP. 74-80

Keywords: 胆管癌，分型，临床表现，危险因素，治疗手段
Cholangiocarcinoma, Typing, Clinical Manifestations, Risk Factors, Treatment

Full-Text   Cite this paper   Add to My Lib

Abstract:

胆管癌，是一种恶性程度较高的肿瘤，临床较少见，占所有恶性肿瘤不足1％，但在中国胆管癌患者数呈逐年增多的趋势，因而胆管癌研究在我国具有特殊意义。胆管癌根据解剖位置的不同分为：肝门部胆管癌(PHC)、远端胆管癌(DCCA)和肝内胆管癌(ICCA)，肝门部胆管癌最为常见。目前，手术治疗是最佳的治疗手段，但由于早期诊断困难，确诊时多为晚期，因此只有不到10%的患者能够耐受手术治疗，但术后复发率较高，生存率低等问题仍然未能解决。随着人们对胆管癌临床治疗研究的不断深入，新的治疗手段逐渐形成。本文归纳分析了胆管癌的分型、临床表现、危险因素、分子生物学机制及其相关治疗手段的研究结果。
Cholangiocarcinoma (CCA), is a highly malignant tumor, clinically rare and accounting for less than 1% of all malignant tumors. But the number of patients with cholangiocarcinoma in China increases year by year, so cholangiocarcinoma research has special significance in our country. Depending on the anatomical location, cholangiocarcinoma is divided into: hilar cholangiocarcinoma (PHC), the distal bile duct (DCCA) and intrahepatic cholangiocarcinoma (ICCA), among which hilar is the most common. Currently, surgery is the best treatment, but because early diagnosis is difficult, most cases are in the end-stage when diagnosed; therefore, less than 10% of patients are able to tolerate surgery. However the high recurrence rate and low survival rate are still unresolved. With clinical treatment of cholangiocarcinoma deepening, new treatments gradually formed. This article summarizes the results of the analysis of the cholangiocarcinoma typing, clinical manifestations, risk factors, molecular biological mechanisms and related treatment.

References

[1]	Siegel, R., Naishadham, D. and Jemal, A. (2013) Cancer statistics, 2013. CA: A Cancer Journal for Clinicians, 63, 11-30.
[2]	Nakeeb, A., Pitt, H.A., Sohn, T.A., Coleman, J., Abrams, R.A., Piantadosi, S., Hruban, R.H., Lillemoe, K.D., Yeo, C.J. and Cameron, J.L. (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. CA: A Cancer Journal for Clinicians, 224, 463-473; discussion 473-475.
[3]	DeOliveira, M.L., Cunningham, S.C., Cameron, J.L., Kamangar, F., Winter, J.M., Lillemoe, K.D., Choti, M.A., Yeo, C.J. and Schulick, R.D. (2007) Cholan-giocarcinoma: Thirty-one-year experience with 564 patients at a single institution. Annals of Surgery, 245, 755-762.
[4]	Klatskin, G. (1965) Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. The American Journal of Medicine, 38, 241-256.
[5]	Nagorney, D.M., Donohue, J.H., Farnell, M.B., et al. (1993) Outcomes after curative resections of cho-langiocarcinoma. Archives of Surgery, 128, 871-877; discussion 877-879.
[6]	Nakeeb, A., Pitt, H.A., Sohn, T.A., et al. (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Annals of Surgery, 224, 463-473; discussion 473-475.
[7]	Welzel, T.M., Mellemkjaer, L., Gloria, G., et al. (2007) Risk factors for intrahepatic cholangiocarcinoma in a low-risk population: A nationwide case-control study. International Journal of Cancer, 120, 638-641.
[8]	Donato, F., Gelatti, U., Tagger, A., et al. (2001) Intrahepatic cholangiocarcinoma and hepatitis C and B virus infection, alcohol intake, and hepatolithiasis: A case-control study in Italy. Cancer Causes & Control, 12, 959-964.
[9]	El-Serag, H.B., Engels, E.A., Landgren, O., et al. (2009) Risk of hepatobiliary and pancreatic cancers after hepatitis C virus infection: A population-based study of U.S. veterans. Hepatology, 49, 116-123.
[10]	Shaib, Y.H., El-Serag, H.B., Davila, J.A., Morgan, R. and McGlynn, K.A. (2005) Risk factors of intrahepatic cholangiocarcinoma in the United States: A case-control study. Gastroenterology, 128, 620-626.
[11]	Lee, T.Y., Lee, S.S., Jung, S.W., Jeon, S.H., Yun, S.C., Oh, H.C., et al. (2008) Hepatitis B virus infection and intrahepatic cholangiocarcinoma in Korea: A case-control study. American Journal of Gastroenterology, 103, 1716-1720.
[12]	Zhou, Y.M., Yin, Z.F., Yang, J.M., Li, B., Shao, W.Y., Xu, F., et al. (2008) Risk factors for intrahepatic cholangiocarcinoma: A case control study in China. World Journal of Gastroenterology, 14, 632-635.
[13]	Sekiya, S. and Suzuki, A. (2012) Intrahepatic cholangiocarcinoma can arise from Notch-mediated conversion of hepatocytes. Journal of Clinical Investigation, 122, 3914-3918.
[14]	Palmer, W.C. and Patel, T. (2012) Are common factors involved in the pathogenesis of primary liver cancers? A meta- analysis of risk factors for intrahepatic cholangiocarcinoma. Journal of Hepatology, 57, 69-76.
[15]	Ben-Menachem, T. (2007) Risk factors for cholangiocarcinoma. European Journal of Gastroenterology & Hepatology, 19, 615-617.
[16]	Chapman, M.H., Webster, G.J., Bannoo, S., Johnson, G.J., Wittmann, J. and Pereira, S.P. (2012) Cholangiocarcinoma and dominant strictures in patients with primary sclerosing cholangitis: A 25-year single-centre experience. European Journal of Gastroenterology & Hepatology, 24, 1051-1058.
[17]	Boberg, K.M., Bergquist, A., Mitchell, S., Pares, A., Rosina, F., Broomé, U., et al. (2002) Cholangiocarcinoma in primary sclerosing cholangitis: Risk factors and clinical presentation. Scandinavian Journal of Gastroenterology, 37, 1205-1211.
[18]	Tyson, G.L. and El-Serag, H.B. (2011) Risk factors for cholangiocarcinoma. Hepatology, 54, 173-184.
[19]	Welzel, T.M., Mellemkjaer, L., Gloria, G., Sakoda, L.C., Hsing, A.W., El Ghormli, L., et al. (2007) Risk factors for intrahepatic cholangiocarcinoma in a low-risk population: A nationwide case-control study. International Journal of Cancer, 120, 638-641.
[20]	S？eide, K., K？ner, H., Havnen, J. and S？eide, J.A. (2004) Bile duct cysts in adults. British Journal of Surgery, 91, 1538-1548.
[21]	Nakanuma, Y., Sato, Y., Harada, K., Sasaki, M., Xu, J. and Ikeda, H. (2010) Pathological classification of intrahepatic cholangiocarcinoma based on a new concept. World Journal of Hepatology, 2, 419-427.
[22]	Huang, M.H., Chen, C.H., Yen, C.M., Yang, J.C., Yang, C.C., Yeh, Y.H., et al. (2005) Relation of hepatolithiasis to helminthic infestation. Journal of Gastroenterology and Hepatology, 20, 141-146.
[23]	Tocchi, A., Mazzoni, G., Liotta, G., Lepre, L., Cassini, D. and Miccini, M. (2001) Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: A follow-up study of more than 1000 patients. Annals of Surgery, 234, 210-214.
[24]	Zhang, W. and Yan, L.N. (2014) Perihilar cholangiocarcinoma: Current therapy. World Journal of Gastrointestinal Pathophysiology, 5, 344-354.
[25]	Jarnagin, W.R., Fong, Y., DeMatteo, R.P., Gonen, M., Burke, E.C., Bodniewicz, B.S.J., Youssef, B.A.M., Klimstra, D. and Blumgart, L.H. (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Annals of Surgery, 234, 507-519.
[26]	Ito, F., Agni, R., Rettammel, R.J., Been, M.J., Cho, C.S., Mahvi, D.M., Rikkers, L.F. and Weber, S.M. (2008) Resection of hilar cholangiocarcinoma: Concomitant liver resection decreases hepatic recurrence. Annals of Surgery, 248, 273-279.
[27]	Nagino, M., Ebata, T., Yokoyama, Y., Igami, T., Sugawara, G., Takahashi, Y. and Nimura, Y. (2013) Evolution of surgical treatment for perihilar cholangiocarcinoma: A single-center 34-year review of 574 consecutive resections. Annals of Surgery, 258, 129-140.
[28]	Aljiffry, M., Walsh, M.J. and Molinari, M. (2009) Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009. World Journal of Gastroenterology, 15, 4240-4262.
[29]	Kr Goenka, M. and Goenka, U. (2014) Palliation: Hilar cholangiocarcinoma. World Journal of Hepatology, 6, 559- 569.
[30]	Valle, J., Wasan, H., Palmer, D.H., Cunningham, D., Anthoney, A., Maraveyas, A., et al., for the ABC-02 Trial Investigators (2010) Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. New England Journal of Medicine, 362, 1273-1281.
[31]	Geynisman, D.M. and Catenacci, D.V. (2012) Toward per-sonalized treatment of advanced biliary tract cancers. Discovery Medicine, 14, 41-57.
[32]	Hezel, A.F., Deshpande, V. and Zhu, A.X. (2010) Genetics of biliary tract cancers and emerging targeted therapies. Journal of Clinical Oncology, 28, 3531-3540.
[33]	Sia, D., Hoshida, Y., Villanueva, A., Roayaie, S., Ferrer, J., Tabak, B., et al. (2013) Integrative molecular analysis of intrahepatic cholangiocarcinoma reveals 2 classes that have different outcomes. Gastroenterology, 144, 829-840.
[34]	Andersen, J.B., Spee, B., Blechacz, B.R., Avital, I., Komuta, M., Barbour, A., et al. (2012) Genomic and genetic characterization of cholangiocarcinoma identifies therapeutic targets for tyrosine kinase inhibitors. Gastroenterology, 142, 1021-1031.e15.
[35]	Han, W. and Lo, H.W. (2012) Landscape of EGFR signaling network in human cancers: Biology and therapeutic response in relation to receptor subcellular locations. Cancer Letters, 318, 124-134.
[36]	Chung, J.Y., Hong, S.M., Choi, B.Y., Cho, H., Yu, E. and Hewitt, S.M. (2009) The expression of phospho-AKT, phospho-mTOR, and PTEN in extrahepatic cholangiocarcinoma. Clinical Cancer Research, 15, 660-667.
[37]	Lee, D., Do, I.G., Choi, K., Sung, C.O., Jang, K.T., Choi, D., et al. (2012) The expression of phos-pho-AKT1 and phospho-MTOR is associated with a favorable prognosis independent of PTEN expression in intrahepatic cholangiocarcinomas. Modern Pathology, 25, 131-139.
[38]	Wu, Y.M., Su, F., Kalyana-Sundaram, S., Khazanov, N., Ateeq, B., Cao, X.H., et al. (2013) Identification of targetable FGFR gene fusions in diverse cancers. Cancer Discovery, 3, 636-647.
[39]	Philip, P.A., Mahoney, M.R., Allmer, C., Thomas, J., Pitot, H.C., Kim, G., Donehower, R.C., Fitch, T., Picus, J. and Erlichman, C. (2006) Phase II study of erlotinib in patients with advanced biliary cancer. Journal of Clinical Oncology, 24, 3069-3074.
[40]	Lubner, S.J., Mahoney, M.R., Kolesar, J.L., Loconte, N.K., Kim, G.P., Pitot, H.C., Philip, P.A., Picus, J., Yong, W.P., Horvath, L., Van Hazel, G., Erlichman, C.E. and Holen, K.D. (2010) Report of a multicenter phase II trial testing a combination of biweekly bevacizumab and daily erlotinib in patients with unresectable biliary cancer: A phase II Consortium study. Journal of Clinical Oncology, 28, 3491-3497.
[41]	Tai, C.J., Chiou, H.Y., Wu, C.H., Pan, S. and Liu, J.D. (2006) Rapid resolution of liver metastasis from cholangiocarcinoma after bevacizumab with cisplatin and highdose fluorouracil plus leucovorin. Onkologie, 29, 179-180.
[42]	Zhu, A.X., Meyerhardt, J.A., Blaszkowsky, L.S., Kambadakone, A.R., Muzikansky, A., Zheng, H., Clark, J.W., Abrams, T.A., Chan, J.A., Enzinger, P.C., Bhargava, P., Kwak, E.L., Allen, J.N., Jain, S.R., Stuart, K., Horgan, K., Sheehan, S., Fuchs, C.S., Ryan, D.P. and Sahani, D.V. (2010) Efficacy and safety of gemcitabine, oxaliplatin, and bevacizumab in advanced biliary-tract cancers and correlation of changes in 18-fluorodeoxyglucose PET with clinical outcome: A phase 2 study. Lancet Oncology, 11, 48-54.
[43]	Bengala, C., Bertolini, F., Malavasi, N., Boni, C., Aitini, E., Dealis, C., Zironi, S., Depenni, R., Fontana, A., Del Giovane, C., Luppi, G. and Conte, P. (2010) Sorafenib in patients with advanced biliary tract carcinoma: A phase II trial. British Journal of Cancer, 102, 68-72.

Full-Text