Pathogenesis, diagnosis, and management of cholangiocarcinoma.
Pathogenesis, diagnosis, and management of cholangiocarcinoma.
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DOI：
10.1053/j.gastro.2013.10.013
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发表时间：
2013-12
期刊：
影响因子：
29.4
通讯作者：
Gores GJ
中科院分区：
文献类型：
--
作者：
Ilyas SI;Gores GJ
胆管癌（CCA）是具有胆管细胞分化特征的肝胆癌;它们可以在解剖学上分为肝内（iCCA）、肝门周围（pCCA）或远端CCA（dCCA）。这些亚型不仅在解剖位置上不同，而且在流行病学、起源、病因、发病机制和治疗上也不同。iCCA的发病率和死亡率在过去的30年中一直在增加，只有很低比例的患者存活到诊断后5年。CCA发病率的地理差异与危险因素的变化有关。致癌基因和炎症信号通路的变化，以及遗传和表观遗传改变和染色体畸变，已被证明有助于CCA的发展。此外，CCA被致密的基质包围，其中含有许多癌症相关的成纤维细胞，这促进了它们的进展。我们对iCCAs的影像学特征有了更好的了解，并开发了先进的细胞学技术来检测pCCAs。iCCAs患者通常采用手术治疗，而新辅助放化疗后的肝移植是pCCAs患者的一种选择。本文就CCA的流行病学、发病机制、分类、诊断和治疗等方面的进展作一综述，沿着。
Cholangiocarcinomas (CCAs) are hepatobiliary cancers with features of cholangiocyte differentiation; they can be classified anatomically as intrahepatic (iCCA), perihilar (pCCA), or distal CCA (dCCA). These subtypes differ not only in their anatomic location but in epidemiology, origin, etiology, pathogenesis, and treatment. The incidence and mortality of iCCA has been increasing over the past 3 decades, and only a low percentage of patients survive until 5 y after diagnosis. Geographic variations in the incidence of CCA are related to variations in risk factors. Changes in oncogene and inflammatory signaling pathways, as well as genetic and epigenetic alterations and chromosome aberrations, have been shown to contribute to development of CCA. Furthermore, CCAs are surrounded by a dense stroma that contains many cancer-associated fibroblasts, which promotes their progression. We have gained a better understanding of the imaging characteristics of iCCAs and have developed advanced cytologic techniques to detect pCCAs. Patients with iCCAs are usually treated surgically, whereas liver transplantation following neoadjuvant chemoradiation is an option for a subset of patients with pCCAs. We review recent developments in our understanding of the epidemiology, pathogenesis, of CCA, along with advances in classification, diagnosis and treatment.
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