ABSTRACT

Introduction: Peri-hilar cholangiocarcinoma is an aggressive bile duct cancer. Long-term survival is possible with margin-negative surgery. Historically, unresectable disease was approached with non-curative treatment options. In recent decades, an innovative approach of neoadjuvant chemoradiation and liver transplantation has demonstrated long-term survival for highly selected patients.

Areas covered: This is a critical analysis of studies published to date on neoadjuvant chemoradiation and liver transplantation for selected patients with peri-hilar cholangiocarcinoma. A PubMed literature search was conducted for years 1970–2020 with the following search criteria: [‘hilar’ OR ‘peri-hilar’ AND ‘cholangiocarcinoma’] AND [‘treatment’ OR ‘transplantation’ OR ‘survival’ OR ‘outcome’]; ‘neoadjuvant chemoradiation’ AND ‘unresectable cholangiocarcinoma’. All peer-reviewed original research studies were selected for review.

Expert opinion: Neoadjuvant chemoradiation and liver transplantation for patients with early stage unresectable peri-hilar cholangiocarcinoma can achieve long-term survival in highly selected patients who survive to transplantation without disease progression. There are observed differences in survival for patients with PSC-associated versus de novo cholangiocarcinoma and transplanted versus resected patients; however, these differences are not contextualized by established tumor and patient factors that influence recurrence and survival. Therefore, these results must be interpreted within the limitations of the study designs upon which they are based.

摘要

简介: 肝门周围胆管癌是一种侵袭性胆管癌。切缘阴性手术有可能获得长期生存。从历史上看，不可切除的疾病是通过非治愈性的治疗选择来处理的。近几十年来，新辅助放化疗和肝移植的创新方法已证明对高度选择的患者具有长期生存率。

涵盖的领域：这是对迄今为止已发表的针对特定肝门周围胆管癌患者的新辅助放化疗和肝移植研究的批判性分析。使用以下搜索标准对 1970-2020 年的 PubMed 文献进行了检索：['hilar' OR 'peri-hilar' AND 'cholangiocarcinoma'] AND ['treatment' OR 'transplantation' OR 'survival' OR 'outcome'] ; “新辅助放化疗”和“不可切除的胆管癌”。所有经过同行评审的原始研究都被选中进行评审。

专家意见：对于早期不可切除的肺门周围胆管癌患者，新辅助放化疗和肝移植可以在高度选择的患者中获得长期生存，这些患者可以存活至移植而没有疾病进展。观察到 PSC 相关患者与新发胆管癌患者以及移植患者与切除患者的生存率存在差异；然而，这些差异并未受到影响复发和生存的既定肿瘤和患者因素的影响。因此，必须在它们所基于的研究设计的限制范围内解释这些结果。