Intrahepatic cholangiocarcinoma: current perspectives

Abstract

Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy arising from the liver. ICC makes up about 10% of all cholangiocarcinomas. It arises from the peripheral bile ducts within the liver parenchyma, proximal to the secondary biliary radicals. Histologically, the majority of ICCs are adenocarcinomas. Only a minority of patients (15%) present with resectable disease, with a median survival of less than 3 years. Multidisciplinary management of ICC is complicated by large differences in disease course for individual patients both across and within tumor stages. Risk models and nomograms have been developed to more accurately predict survival of individual patients based on clinical parameters. Predictive risk factors are necessary to improve patient selection for systemic treatments. Molecular differences between tumors, such as in the epidermal growth factor receptor status, are promising, but their clinical applicability should be validated. For patients with locally advanced disease, several treatment strategies are being evaluated. Both hepatic arterial infusion chemotherapy with floxuridine and yttrium-90 embolization aim to downstage locally advanced ICC. Selected patients have resectable disease after downstaging, and other patients might benefit because of postponing widespread dissemination and biliary obstruction.

A novel online prognostic tool to predict long‐term survival after liver resection for intrahepatic cholangiocarcinoma: The “metro‐ticket” paradigm

“…In contrast to previous studies, which have included only two or three factors in the prediction of OS, our calculator assigned weights to each of the variables included in the multivariable model. Indeed, previous multi‐institutional and registry analyses have demonstrated that except for tumor size and number, other factors such as CA19‐9 levels, margin, and lymph node status as well as major and microscopic vascular invasion are important determinants of long‐term outcomes, and, thus, should be taken into account when predicting the OS of patients with ICC . As such, our calculator could provide a more accurate prediction of long‐term outcomes for patients undergoing surgery for ICC.…”

Inflammatory markers in intrahepatic cholangiocarcinoma: Effects of advanced liver disease

“…ICC carries a dismal prognosis, with 3‐ and 5‐year survival rates of 30% and 18% . Surgical resection is recommended whenever possible; however, as few as 15% of patients may present with inoperable disease . For those who are not surgical candidates, systemic chemotherapy is the standard of treatment .…”

Performance of prognostic scores and staging systems in predicting long‐term survival outcomes after surgery for intrahepatic cholangiocarcinoma

“…Intrahepatic cholangiocarcinoma (ICC) occurs in approximately 1‐2 per 100 000 persons, making it the second most common primary hepatic malignancy . Although ICC mostly develops as a well‐differentiated carcinoma, only a minority (15%) of patients presents with resectable disease at the time of diagnosis . Complete surgical resection remains the only option for cure.…”