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    Home > Active Ingredient News > Digestive System Information > China's first consensus on the diagnosis and treatment of intrahepatic bile duct carcinoma 16 key recommendations to open a new journey of standardized diagnosis and treatment of intrahepatic cholangiocarcinoma

    China's first consensus on the diagnosis and treatment of intrahepatic bile duct carcinoma 16 key recommendations to open a new journey of standardized diagnosis and treatment of intrahepatic cholangiocarcinoma

    • Last Update: 2022-09-21
    • Source: Internet
    • Author: User
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    According to statistics, the incidence of intrahepatic cholangiocarcinoma (ICC) accounts for about 10% to 15%



    Recently, the "Consensus on the Diagnosis and Treatment of Primary Liver Cancer Diagnosis and Treatment Guidelines for Intrahepatic Bile Duct Carcinoma", jointly drafted by multidisciplinary experts in the field of liver cancer in China, was officially released





    Academician Fan Jia joined the ranks of standardization to build a healthy China


    Fan Jia, chairman of the Consensus Writing Expert Committee and academician of the Chinese Academy of Sciences, pointed out that in recent years, targeted drugs, immune drugs and other treatment options have continued to emerge and continue to develop, accelerating the process



    Reaching a consensus will improve ICC early diagnosis rates, optimize treatment protocols, and achieve good clinical outcomes



    Professor Shen Feng accelerated the standardization process of intrahepatic cholangiocarcinoma


    Professor Shen Feng, a representative of the Consensus Editorial Board and Shanghai Oriental Hepatobiliary Surgery Hospital, said that the incidence of ICC has increased significantly nationwide, and the mortality rate is extremely high, and it is necessary



    With the continuous increase of ICC treatment methods and the continuous emergence of treatment methods, on the basis of evidence-based medicine, the consensus combines the essence of related fields around the world, standardizes the diagnosis and treatment behavior of ICC, and provides a good reference for


    Professor Zhou Jian achieved a breakthrough from "0" to "1"

    Professor Zhou Jian, a representative of the consensus editorial board and Zhongshan Hospital affiliated to Fudan University, said that before the consensus was formulated, the domestic comprehensive diagnosis and treatment guidelines or consensus for intrahepatic cholangiocarcinoma were still blank
    .

    The previous consensus or guidelines only covered the diagnosis and treatment of hilar bile duct carcinoma, or the treatment of distal bile duct carcinoma, so it is imperative to establish a clinical diagnosis and treatment specification for intrahepatic cholangiocarcinoma in China
    .

    Initiated by the Cholangiocarcinoma Collaborative Group of the Chinese Anti-Cancer Association and jointly drafted by multidisciplinary experts in the field of liver cancer in China, the consensus opened a new journey
    of standardized diagnosis and treatment of intrahepatic bile duct cancer in China by reviewing the relevant evidence of the treatment of intrahepatic bile duct carcinoma and combining the clinical practice of intrahepatic bile duct cancer.

    Shouldering the historical mission and strengthening the confidence to move forward, we should continue to achieve new breakthroughs
    from "0" to "1".

    Professor Sun Huichuan's diagnosis and treatment is moving towards standardization and comprehensiveness

    Professor Sun Huichuan, Secretary General of the Consensus Editorial Board and Zhongshan Hospital Affiliated to Fudan University, introduced that the domestic comprehensive diagnosis and treatment guidelines or consensus for intrahepatic cholangiocarcinoma are blank, and the existing biliary tract cancer guidelines have not been able to make detailed recommendations for intrahepatic bile duct cancer, and it is difficult to reach a consensus
    .

    After many consensus expert discussions, revision of the established content, and democratic voting recommendation intensity, the consensus was finalized in July this year, and this time it was released
    under the witness of authoritative experts and media in the field.

    In the future, the research of cholangiocarcinoma will enter a more standardized and comprehensive stage to help achieve "Healthy China 2030"
    .

    Consensus 16 key recommendations


    (The level of evidence in evidence-based medicine is graded according to the Oxford Centre for Evidence-Based Medicine 2011 Edition)

    1

    ICC diagnosis and treatment must adopt a multidisciplinary comprehensive treatment model
    .

    2

    The MDT of the ICC should be composed of at least (recommended) a representative of hepatobiliary surgery, medical oncology, pathology, interventional therapy, transplantation, radiotherapy, gastroenterology, and radiography to provide consistent diagnosis, treatment, and management recommendations
    to patients in specific healthcare settings.

    3

    CA19-9 and CEA are the most commonly used serological markers in ICC and have diagnostic and predictive efficacy value (evidence level: 3, recommended level: strong recommendation
    ).

    4

    Conventional ultrasound, ultrasonography, CT, MRI, PET/CT are all effective adjunctive tests for diagnosing ICC, and DCE-MRI has obvious advantages (level 3, strongly recommended
    ).

    5

    Imaging tests for evaluating ICC efficacy can be SELECTED ASUS, CT/MRI, or PET/CT, but MRI (grade 3, strongly recommended)
    is preferred.

    6

    For patients who are inoperable, a histopathological diagnosis is recommended prior to receiving systemic chemotherapy, radiation therapy, or therapeutic clinical trials
    .

    Image-guided means for ICC biopsy or topical therapy may be selected as ultrasound or CT (grade 3, strongly recommended
    ).

    7

    It is recommended that the mass ICC be taken according to the 7-point sampling method and observe whether there is microvascular invasion (MVI); The number of lymph nodes detected is as large as 6 as possible
    .

    For peritual infiltrative and intratustal growth ICC, the bold tube should be cut along the lesion, and the tumor and the liver tissue around the bile duct should be resected in a long path, and special attention should be paid to measuring the closest distance of the tumor to the bile duct incision margin (grade 3, strong recommendation
    ).

    8

    For stage I.
    B and phase II ICs without vascular invasion, anatomical hepatic resection (grade 3, strongly recommended)
    is recommended after rigorous evaluation.

    9

    After a rigorous surgical safety assessment, it is recommended that the width of the hepatic margin of radical resection ICC strive to ≥ 10 mm (grade 3, strongly recommended
    ).

    10

    For patients with a definitive diagnosis (including definitive intraoperative pathology) of ICC, routine lymph node dissection is recommended (grade 3, strongly recommended
    ).

    11

    Intraoperative cryosylic histopathology is recommended for patients with difficulty diagnosing ICC to reduce the probability of Nx (grade 3, strongly recommended
    ).

    12

    Capecitabine can be used as adjuvant chemotherapy (grade 2, strongly recommended)
    after radical resection in ICC.

    13

    Preoperative PET-CT is recommended in conditional conditions, and diagnostic laparoscopy is performed after PET-CT in conditional cases (Grade 3, strongly recommended); A rapid intraoperative frozen biopsy (level 3, strongly recommended)
    is recommended in a conditional hospital.

    14

    Recommend an individualized hypophase treatment plan with chemotherapy combined with targeted, immune and other therapeutic methods, and recommend that the whole process be evaluated by a multidisciplinary team; Its long-term effects are recommended for RCT studies or cohort study exploration (level 3, strongly recommended
    ).

    15

    Recommend a combination regimen of gemcitabine plus platinum drugs (Grade 1, strong recommendation); Conditions permit the combination of valliyumab (grade 1, strongly recommended)
    on the basis of a combination of platinum drugs.

    16

    Genetic testing is recommended in ICC patients, and pemetinib is recommended for FGFR2 fusion or rearrangement (grade 3, strongly recommended); Emtrictinib or lalotinib (grade 3, strongly recommended)
    is recommended for those who have been positive for NTRK fusion.


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