肝癌电子杂志 ›› 2026, Vol. 13 ›› Issue (1): 1-21.
• 指南与共识 • 下一篇
中国医疗保健国际交流促进会肝脏肿瘤学分会, 中国医疗保健国际交流促进会肿瘤免疫治疗学分会, 中国医师协会肝癌专业委员会, 中国抗癌协会肝癌专业委员会
收稿日期:2026-01-08
出版日期:2026-03-30
发布日期:2026-05-21
通讯作者:
蔡建强,E-mail：caijianqiang188@sina.com; 陈敏山,E-mail：chenmsh@sysucc.org.cn; 程树群,E-mail：chengshuqun@aliyun.com; 栗光明,E-mail：liguangming917@163.com
Received:2026-01-08
Online:2026-03-30
Published:2026-05-21
中国医疗保健国际交流促进会肝脏肿瘤学分会, 中国医疗保健国际交流促进会肿瘤免疫治疗学分会, 中国医师协会肝癌专业委员会, 中国抗癌协会肝癌专业委员会. 胆道恶性肿瘤围手术期治疗中国专家共识[J]. 肝癌电子杂志, 2026, 13(1): 1-21.
| [1] BENSON A B, D'ANGELICA M I, ABRAMS T, et al. Biliary tract cancers, version 2. 2025, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2025, 23(9): 403-418. [2] VOGEL A, BRIDGEWATER J, EDELINE J, et al.Biliary tract cancer: ESMO clinical practice guideline for diagnosis, treatment and followup[J]. Ann Oncol, 2023, 34(2): 127-140. [3] SØREIDE K, DOPAZO C, BERREVOET F, et al. Biliary tract cancer[J]. Eur J Surg Oncol, 2025, 51(6): 108489. [4] RIZZO A, RICCI A D, BRANDI G.Recent advances of immunotherapy for biliary tract cancer[J]. Expert Rev Gastroenterol Hepatol, 2021, 5(5): 527-536. [5] BRAY F, LAVERSANNE M, SUNG H, et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263. [6] QI J L, LI M L, WANG L J, et al.National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data[J]. Lancet Public Health, 2023, 8(12): e943-e955. [7] ZENG H M, CHEN W Q, ZHENG R S, et al.Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5): e555-e567. [8] SONG H W, CHEN C, SHEN H X, et al.Squamous/adenosquamous carcinoma of the gallbladder: analysis of 34 cases and comparison of clinicopathologic features and surgical outcomes with adenocarcinoma[J]. J Surg Oncol, 2015, 112(6): 677-680. [9] LAMARCA A, EDELINE J, MCNAMARA M G, et al.Current standards and future perspectives in adjuvant treatment for biliary tract cancers[J]. Cancer Treat Rev, 2020, 84: 101936. [10] LAMARCA A, EDELINE J, GOYAL L.How I treat biliary tract cancer[J]. ESMO Open, 2022, 7(1): 100378. [11] 吴逸凡, 常仁安, 王明达. 胆道恶性肿瘤新辅助与辅助治疗研究进展[J]. 临床肿瘤学杂志, 2025, 30(3): 287-293. [12] 中国临床肿瘤学会指南工作委员会. CSCO胆道恶性肿瘤诊疗指南(2024版)[M]. 北京: 人民卫生出版社, 2024. [13] DHARANIKOTA H, DICK L, WIGMORE S J, et al.Not all MDTs are created equal: international survey of HPB MDT practices[J]. HPB (Oxford), 2024, 26(11): 1399-1410. [14] 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专家工作组. 胆道恶性肿瘤全程规范化管理中国专家共识(2023)[J]. 中华外科杂志, 2024, 62(6): 504-513. [15] 中国研究型医院学会精准医学与肿瘤MDT专业委员会. 中国胆道肿瘤多学科综合治疗专家共识[J/CD]. 肿瘤综合治疗电子杂志, 2023, 9(3): 57-68. [16] SHI G M, FAN J, ZHOU J, et al.Neoadjuvant GOLP in resectable high-risk intrahepatic cholangiocarcinoma[J]. N Engl J Med, 2026, 394(10): 983-995. [17] LE ROY B, GELLI M, PITTAU G, et al.Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma[J]. Br J Surg, 2018, 105(7): 839-847. [18] WIEDMANN M, CACA K, BERR F, et al.Neoadjuvant photodynamic therapy as a new approach to treating hilar cholangiocarcinoma: a phase Ⅱ pilot study[J]. Cancer, 2003, 97(11): 2783-2790. [19] ZHOU Y, WANG Q, LIN M, et al.Survival benefit of conversion surgery for initially unresectable biliary tract cancer: a systematic review and meta-analysis[J]. Langenbecks Arch Surg, 2025, 410(1): 63. [20] WILBUR H C, SOARES H P, AZAD N S.Neoadjuvant and adjuvant therapy for biliary tract cancer: advances and limitations[J]. Hepatology, 2025, 82(5): 1287-1302. [21] GOETZE T O, VOGEL A, PRATSCHKE J, et al.Neoadjuvant chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone followed by adjuvant therapy in biliary tract cancer: final results from the phase Ⅲ AIO/CALGP/ACO-GAiN-trial[J]. J Clin Oncol, 2025, 43(16_suppl): 4008. [22] MAITHEL S K, KEILSON J M, CAO H S T, et al. NEO-GAP: a single-arm, phase Ⅱ feasibility trial of neoadjuvant gemcitabine, cisplatin, and nab-paclitaxel for resectable, high-risk intrahepatic cholangiocarcinoma[J]. Ann Surg Oncol, 2023, 30(11): 6558-6566. [23] LI R T, LIU Y, LIU Y Y, et al.Durvalumab plus gemcitabine/cisplatin/nab-paclitaxel in resectable biliary tract cancer: a phase Ⅱ, single-arm, open-label study (DurGAP)[J]. J Clin Oncol, 2024, 42(16_suppl): e16260. [24] CHENG Y, LI X.Design of studies on neoadjuvant therapy for intrahepatic cholangiocarcinoma[J]. Heliyon, 2024, 11(2): e41356. [25] ENGINEER R, PATKAR S, LEWIS S C, et al.A phase Ⅲ randomized clinical trial evaluating perioperative therapy (neoadjuvant chemotherapy versus chemoradiotherapy) in locally advanced gallbladder cancers (POLCAGB)[J]. J Clin Oncol, 2025, 43: 4007. [26] MASON M C, MASSARWEH N N, TZENG C D, et al.Time to rethink upfront surgery for resectable intrahepatic cholangiocarcinoma? Implications from the neoadjuvant experience[J]. Ann Surg Oncol, 2021, 28(11): 6725-6735. [27] NELSON J W, GHAFOORI A P, WILLETT C G, et al.Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma[J]. Int J Radiat Oncol Biol Phys, 2009, 73(1): 148-153. [28] KATAYOSE Y, NAKAGAWA K, YOSHIDA H, et al.Neoadjuvant chemoradiation therapy for cholangiocarcinoma to improve R0 resection rate: the first report of phaseⅡstudy[J]. J Clin Oncol, 2015, 33(3_suppl): 402. [29] JUNG J H, LEE H J, LEE H S, et al.Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma[J]. World J Gastroenterol, 2017, 23(18): 3301-3308. [30] MCMASTERS K M, TUTTLE T M, LEACH S D, et al.Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma[J]. Am J Surg, 1997, 174(6): 605-608. [31] KOBAYASHI S, TOMOKUNI A, GOTOH K, et al.Evaluation of the safety and pathological effects of neoadjuvant full-dose gemcitabine combination radiation therapy in patients with biliary tract cancer[J]. Cancer Chemother Pharmacol, 2015, 76(6): 1191-1198. [32] LIU Q, CHANG Z, ZHAO G, et al.Tislelizumab in combination with GEMOX and lenvatinib for conversion therapy of unresectable extrahepatic biliary tract carcinoma (eBTC): a prospective, single-arm, phase 2 study[J]. J Clin Oncol, 2024, 42(16_suppl): e16163. [33] KATO A, SHIMIZU H, OHTSUKA M, et al. Downsizing chemotherapy for initially unresectable locally advanced biliary tract cancer patients treated with gemcitabine plus cisplatin combination therapy followed by radical surgery[J]. Ann Surg Oncol, 2015, 22 Suppl 3: S1093-1099. [34] SHROFF R T, JAVLE M M, XIAO L, et al.Gemcitabine, cisplatin, and nab-paclitaxel for the treatment of advanced biliary tract cancers: a phase 2 clinical trial[J]. JAMA Oncol, 2019, 5(6): 824-830. [35] CHAUDHARI V A, OSTWAL V, PATKAR S, et al.Outcome of neoadjuvant chemotherapy in "locally advanced/borderline resectable" gallbladder cancer: the need to define indications[J]. HPB (Oxford), 2018, 20(9): 841-847. [36] KOSAKA H, MATSUI K, IKEURA T, et al.Prognostic impact of combination therapy with gemcitabine and cisplatin plus S-1 and subsequent conversion surgery for initially unresectable upper biliary tract cancers[J]. Surg Today, 2025, 55(3): 351-359. [37] YOO C, PARK J O, KIM K P, et al.Neoadjuvant durvalumab plus gemcitabine and cisplatin (D+GemCis) versus gemcis alone for localized biliary tract cancer (BTC): results of a randomized, multicenter, open-label, phase Ⅱ trial (DEBATE)[J]. Ann Oncol, 2023, 34: S216. [38] ZHANG Q Y, LIU X Y, WEI S M, et al.Lenvatinib plus PD-1 inhibitors as first-line treatment in patients with unresectable biliary tract cancer: a single-arm, open-label, phase Ⅱ study[J]. Front Oncol, 2021, 11: 751391. [39] SHI G M, HUANG X Y, WU D, et al.Toripalimab combined with lenvatinib and GEMOX is a promising regimen as first-line treatment for advanced intrahepatic cholangiocarcinoma: a single-center, single-arm, phase 2 study[J]. Signal Transduct Target Ther, 2023, 8(1): 106. [40] FAN J, ZHOU J, SHI G M, et al.A single-arm, multi-center phase Ⅱ study of tislelizumab combined with lenvatinib and GEMOX as conversion therapy in potentially resectable locally advanced biliary tract cancer (ZSAB-TransGOLP): a primary analysis[J]. J Clin Oncol, 2024, 42(3_suppl): 488. [41] CERCEK A, BOERNER T, TAN B R, et al.Assessment of hepatic arterial infusion of floxuridine in combination with systemic gemcitabine and oxaliplatin in patients with unresectable intrahepatic cholangiocarcinoma: a phase 2 clinical trial[J]. JAMA Oncol, 2020, 6(1): 60-67. [42] ZHAO R C, ZHOU J, MIAO Z X, et al.Efficacy and safety of lenvatinib plus durvalumab combined with hepatic arterial infusion chemotherapy for unresectable intrahepatic cholangiocarcinoma[J]. Front Immunol, 2024, 15: 1397827. [43] LE V H, O'CONNOR V V, LI D, et al. Outcomes of neoadjuvant therapy for cholangiocarcinoma: A review of existing evidence assessing treatment response and R0 resection rate[J]. J Surg Oncol, 2021, 123(1): 164-171. [44] SUMIYOSHI T, SHIMA Y, OKABAYASHI T, et al.Chemoradiotherapy for initially unresectable locally advanced cholangiocarcinoma[J]. World J Surg, 2018, 42(9): 2910-2918. [45] RIBY D, MAZZOTTA A D, BERGEAT D, et al.Downstaging with radioembolization or chemotherapy for initially unresectable intrahepatic cholangiocarcinoma[J]. Ann Surg Oncol, 2020, 27(10): 3729-3737. [46] RAYAR M, SULPICE L, EDELINE J, et al.Intra-arterial yttrium-90 radioembolization combined with systemic chemotherapy is a promising method for downstaging unresectable huge intrahepatic cholangiocarcinoma to surgical treatment[J]. Ann Surg Oncol, 2015, 22(9): 3102-3108. [47] WANG S S, WANG Y C, ZHU C P, et al.Conversion surgery intervention versus continued systemic therapy in patients with a response after PD-1/PD-L1 inhibitor-based combination therapy for initially unresectable biliary tract cancer: a retrospective cohort study[J]. Int J Surg, 2024, 110(8): 4608-4616. [48] KOBAYASHI S, WADA H, SAKAI D, et al.Impact of tumor shrinkage pattern with biweekly triplet gemcitabine+cisplatin+S-1 regimen for biliary tract cancers: implications for neoadjuvant therapy from the data of KHBO1401 (KHBO1401-1A study)[J]. Oncology, 2024, 102(6): 447-456. [49] 中国抗癌协会肝癌专业委员会转化治疗协作组. 原发性肝癌转化及围手术期治疗中国专家共识(2024版)[J]. 中华消化外科杂志, 2024, 23(4): 492-513. [50] 中国抗癌协会肿瘤介入学专业委员会. 梗阻性黄疸经皮肝穿刺胆道引流及支架植入术专家共识(2018)[J]. 临床肝胆病杂志, 2019, 35(3): 504-508. [51] WANG Y Z, ZHAO X B, SHE Y, et al.The clinical efficacy and safety of different biliary drainage in malignant obstructive jaundice: a meta-analysis[J]. Front Oncol, 2024, 14: 1370383. [52] 中华医学会外科学分会胆道外科学组. 胆囊癌诊断和治疗指南(2019版)[J]. 中华外科杂志, 2020, 58(4): 243-251. [53] ROSEN C B, HEIMBACH J K, GORES G J.Liver transplantation for cholangiocarcinoma[J]. Transpl Int, 2010, 23(7): 692-697. [54] SAPISOCHIN G, FACCIUTO M, RUBBIA-BRANDT L, et al.iCCA International Consortium. Liver transplantation for "very early" intrahepatic cholangiocarcinoma: international retrospective study supporting a prospective assessment[J]. Hepatology, 2016, 64(4): 1178-1188. [55] MCMILLAN R R, JAVLE M, KODALI S, et al. Survival following liver transplantation for locally advanced, unresectable intra-hepatic cholangiocarcinoma[J]. Am J Transplant, 2022, 22(3): 823‐832. [56] DE VREEDE I, STEERS J L, BURCH P A, et al.Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma[J]. Liver Transpl, 2000, 6(3): 309-316. [57] WOO S M, KIMCHY A V, SEQUEIRA L M, et al.Immunotherapy use prior to liver transplant in patients with hepatocellular carcinoma[J]. Curr Oncol, 2022, 29(12): 9813-9825. [58] PRIMROSE J N, FOX R P, PALMER D H, et al.Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study[J]. Lancet Oncol, 2019, 20(5): 663-673. [59] NAKACHI K, IKEDA M, KONISHI M, et al.Adjuvant S-1 compared with observation in resected biliary tract cancer (JCOG1202, ASCOT): a multicentre, open-label, randomised, controlled, phase 3 trial[J]. Lancet, 2023, 401(10372): 195-203. [60] EDELINE J, BENABDELGHANI M, BERTAUT A, et al.Gemcitabine and oxaliplatin chemotherapy or surveillance in resected biliary tract cancer (PRODIGE 12-ACCORD 18-UNICANCER GI): a randomized phase Ⅲ study[J]. J Clin Oncol, 2019, 37(8): 658-667. [61] EBATA T, HIRANO S, KONISHI M, et al.Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer[J]. Br J Surg, 2018, 105(3): 192-202. [62] YOO C, JEONG H, KIM K P, et al.Adjuvant gemcitabine plus cisplatin (GemCis) versus capecitabine (CAP) in patients (pts) with resected lymph node (LN)-positive extrahepatic cholangiocarcinoma (CCA): A multicenter, open-label, randomized, phase 2 study (STAMP)[J]. J Clin Oncol, 2022, 40(16_suppl): 4019. [63] YANG L, LU L, WANG X, et al.Adjuvant tislelizumab combined with capecitabine for patients with biliary tract cancer with high risk of postoperative relapse (ACTIVE): primary analysis from a prospective cohort study[J]. J Clin Oncol, 2024, 42(suppl16): e16248. [64] BEN-JOSEF E, GUTHRIE K A, EL-KHOUEIRY A B, et al. SWOG S0809: A phase Ⅱ intergroup trial of adjuvant capecitabine and gemcitabine followed by radiotherapy and concurrent capecitabine in extrahepatic cholangiocarcinoma and gallbladder carcinoma[J]. J Clin Oncol, 2015, 33(24): 2617-2622. [65] CHO S Y, KIM S H, PARK S J, et al.Adjuvant chemoradiation therapy in gallbladder cancer[J]. J Surg Oncol, 2010, 102(1): 87-93. [66] REN B X, GUO Q, YANG Y Q, et al.A meta-analysis of the efficacy of postoperative adjuvant radiotherapy versus no radiotherapy for extrahepatic cholangiocarcinoma and gallbladder carcinoma[J]. Radiat Oncol, 2020, 15(1): 15. [67] XIAO H, JI J, LI S, et al.Adjuvant chemoradiation and immunotherapy for extrahepatic cholangiocarcinoma and gallbladder cancer: a randomized clinical trial[J]. JAMA Oncol, 2025, 10: e251926. [68] VERN-GROSS T Z, SHIVNANI A T, CHEN K, et al. Survival outcomes in resected extrahepatic cholangiocarcinoma: effect of adjuvant radiotherapy in a surveillance, epidemiology, and end results analysis[J]. Int J Radiat Oncol Biol Phys, 2011, 81(1): 189-198. [69] SHINOHARA E T, MITRA N, GUO M, et al.Radiation therapy is associated with improved survival in the adjuvant and definitive treatment of intrahepatic cholangiocarcinoma[J]. Int J Radiat Oncol Biol Phys, 2008, 72(5): 1495-1501. [70] SUR M D, IN H, SHARPE S M, et al.Defining the benefit of adjuvant therapy following resection for intrahepatic cholangiocarcinoma[J]. Ann Surg Oncol, 2015, 22(7): 2209-2217. [71] ZHENG X, CHEN B, WU J X, et al.Benefit of adjuvant radiotherapy following narrow-margin hepatectomy in patients with intrahepatic cholangiocarcinoma that adhere to major vessels[J]. Cancer Manag Res, 2018, 10: 3973-3981. [72] YANG Z, WANG L, ZHAI Y, et al.Nodal recurrence mapping and clinical target volumes after resection of intrahepatic cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma[J]. Clin Transl Radiat Oncol, 2024, 45: 100749. [73] FULLER C D, WANG S J, CHOI M, et al.Multimodality therapy for locoregional extrahepatic cholangiocarcinoma: a population-based analysis[J]. Cancer, 2009, 115(22): 5175-5183. |
| No related articles found! |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||
