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BackgroundCurrently, the potential benefits of additional resection after positive proximal intraoperative frozen sections (IFS) in perihilar cholangiocarcinoma (pCCA) on residual disease and oncological outcome remain uncertain. Therefore, the aim of this study is to investigate the number of R0 resections after additional resection of a positive proximal IFS and the influence of additional resections on overall survival (OS) in patients with pCCA.Materials and methodsA retrospective, multicenter, matched case-control study was performed, including patients undergoing resection for pCCA between 2000 and 2019 at three tertiary centers. Primary outcome was the number of achieved ‘additional’ R0 resections. Secondary outcomes were OS, recurrence, severe morbidity and mortality.ResultsForty-four out of 328 patients undergoing resection for pCCA had a positive proximal IFS. An additional resection was performed in 35 out of 44 (79.5%) patients, which was negative in 24 (68.6%) patients. Nevertheless, seven out of these 24 patients were eventually classified as R1 resection due to other positive resection margins. Therefore, 17 (48.6%) patients could be classified as “true” R0 resection after additional resection. Ninety-day mortality after R1 resections was high (25%) and strongly influenced OS. After correction for 90-day mortality, median OS after negative additional resection was 33 months (95%CI:29.5–36.5) compared to 30 months (95%CI:24.4–35.6) after initial R1 (P = 0.875) and 46 months (95%CI:32.7–59.3) after initial R0 (P = 0.348).ConclusionThere were only 17 patients (out of a total of 328 patients) that potentially benefitted from routine IFS. Additional resection for a positive IFS leading to R0 resection was not associated with improved long-term survival.  相似文献   
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Background: Betulinic acid (BA), a pentacyclic triterpene glycoside extract from guava (Psidium guajava Linn.) leaves, displays a variety of biological activities which exhibit cancer therapeutic properties associated with cancer growth inhibition in various kinds of human cancer cells including brain, breast, colorectal, cervical, lung and prostate gland. However, the effects on human cholangiocarcinoma cells have not previously been reported. Current study, we evaluated the activity of BA against human cholangiocarcinoma (HuCCA) cells. Methods: The cytotoxicity analysis was measured by using MTT assay on HuCCA and BHK-21 cells. Analysis of apoptosis was evaluated by using staining with Hoechst 33342 and quantitative real-time PCR. Results: The BA (50-800 µg/mL) significantly reduced the viability of HuCCA cells in a dose-dependent action with 50% inhibitory concentration (IC50) of 92.45 µg/mL at 24 h. It also induced apoptosis signaling pathway, such as nuclear chromatin condensation and fragmentation. Quantitative real-time PCR analysis demonstrated that BA increased p53, Bax and caspase-3 expression whilst it decreased Bcl-2 expression in the HuCCA cells in a dose dependent manner. Conclusion: BA can inhibit the HuCCA cell viability and induce apoptosis of neoplastic cells. This study indicates that BA has effective treatment for cholangiocarcinoma in vitro. Consequently, BA may be used as a novel therapeutic agent for the treatment of cholangiocarcinoma in the future.  相似文献   
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The use of radiation for primary liver cancers has historically been limited because of the risk of radiation-induced liver disease. Treatment fields have become more conformal because of several technical advances, and this has allowed for dose escalation. Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, is now able to safely treat liver tumors to ablative doses while sparing functional liver parenchyma by using highly conformal therapy. Several retrospective and small prospective studies have examined the use of SBRT for liver cancers; however, there is a lack of well-powered randomized studies to definitively guide management in these settings. Recent advances in systemic therapy for primary liver cancers have improved outcomes; however, the optimal selection criteria for SBRT as a local therapy remain unclear among other liver-directed options such as radiofrequency ablation, transarterial chemoembolization, and radioembolization.  相似文献   
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BackgroundA comprehensive re-evaluation on the role of trans-arterial chemoembolization (TACE) in patients with intrahepatic cholangiocarcinoma.MethodsA thorough database searching was performed in PubMed, EMBASE, and the Cochrane Library. Eligible studies were restricted to comparative studies between TACE and non-TACE cohorts. RevMan5.3 software and Stata 13.0 software were used for statistical analyses. The primary endpoint of our study was long-term survival.ResultsA total of 11 studies with 2036 patients were finally identified. Pooled results revealed that patients receiving TACE had a significantly better overall survival (OS) versus those without TACE (P < 0.05). Subgroup analyses were performed according to different types of TACE. Prophylactic post-surgical TACE (PPTACE) was associated with a significantly better OS versus those without PPTACE (P < 0.05). Palliative TACE (PTACE) also achieved a significantly better OS compared with those with supportive treatment (ST) only (P < 0.00001). However, TACE had no impact on disease-free survival (P = 0.87) and was less effective than surgical resection (P = 0.003).ConclusionPPTACE has a remarkable impact on OS versus those with surgical resections only and should be regularly performed. Regarding patients with unresectable disease, apart from conventional ST, adjuvant PTACE is also recommended. Upcoming prospective randomized controlled trials are warranted for further validation.  相似文献   
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目的:本研究旨在比较肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)患者手术治疗与手术后联合放疗的生存期,探讨手术后辅助放疗的可行性,为ICC的临床治疗提供依据。方法:提取美国The Surveillance,Epidemiology,and End Results(SEER)数据库2004至2015年间诊断为ICC患者的临床资料, 根据手术后是否放疗,将患者分为手术组(surgery)和手术后放疗组(radiation after surgery),采用Kaplan-Meier方法比较两组总体生存期(overall survival,OS)和肝癌特异性生存期(liver cancer specific survival,LCSS)的差异。在进行了1∶1倾向评分匹配(propensity score matching,PSM)之后,再次比较OS与LCSS的差异。然后进行亚组分析比较手术组与手术后放疗组的疗效。最后收集本院数据对数据库结果进行验证。结果:共有470例患者纳入研究,其中手术组患者410例,手术后放疗组患者60例。PSM前手术组与手术后放疗组的中位OS(19.00个月vs 26.00个月,P=0.268)和中位LCSS(19.00个月 vs 26.00个月,P=0.591)无明显差异,PSM后手术组与手术后放疗组的中位OS(25.50个月 vs 26.00个月,P=0.531)和中位LCSS(27.00个月 vs 26.00个月,P=0.302)亦无明显差异。在亚组分析中,手术后放疗并不是ICC患者总体生存的保护因素。本院数据结果与数据库结果一致。结论:ICC患者手术后辅助放疗相较于手术治疗并不会延长患者生存。  相似文献   
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肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)是一种高度侵袭性的恶性肿瘤,由于其病因复杂、起病隐匿,大多数患者预后较差,单一治疗手段的治疗效果不尽人意。因此,对于ICC多学科综合治疗模式的探索及研究至关重要。而介入治疗凭借多样化的治疗方式及更高的患者耐受性可以与多种治疗手段联合应用。本文探讨了介入治疗联合外科治疗、介入治疗联合全身化疗、介入治疗联合免疫治疗及靶向治疗在ICC中的应用以及取得的成果,并对未来ICC的治疗方向做出展望。  相似文献   
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This commentary reviews top advances in hepatobiliary cancer research in 2021–2022, focusing on leveraging immunotherapeutics in combination with other therapies earlier in the disease course and targeted to patient's individualized biomarkers that may predict response or resistance to checkpoint inhibitors.  相似文献   
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