Original article

Cholangiocarcinoma

The aim of this study is to investigate the role of CFHR1 in bile duct carcinoma (BDC) and its mechanism of action, and we hope that our analysis and research will contribute to a better understanding of cholangiocarcinoma (BDC) disease genesis, progression and the development of new therapeutic strategies. The prognostic receiver operating characteristic curve of CFHR1 was generated using survival ROC. The ROC curve for CFHR1 showed that there is a correlation between CFHR1 expression and clinicopathological parameters and has an impact on poor prognosis. STRING was used to predict the protein-protein interaction network of the identified genes, and the Microenvironment Cell Populations counter algorithm was used to analyze immune cell infiltration within the BDC. The combined analysis showed that CFHR1 was found to be upregulated in BDC tissues, along with a total of 20 related differentially expressed genes (DEGs) (8 downregulated and 12 upregulated genes). Also, the results showed that the expression of CFHR1 is correlated with immune cell infiltration in tumor and immune cell markers in BDC (P < 0.05). In addition, we have verified experimentally the biological function of CFHR1. These findings suggest that CFHR1 may be a prognostic marker and a potential therapeutic target for BDC. Information regarding the detailed roles of CFHR1 in BDC could be valuable for improving the diagnosis and treatment of this rare cancer.

Intrahepatic cholangiocarcinoma is the second most common primary liver cancer after hepatocellular carcinoma with an increasing incidence worldwide. Surgical resection is still the only potential cure, and survival rates are dismal due to disease relapse after resection and/or metastatic disease. Positive resection margins are associated with recurrence, with conflicting studies regarding the benefits of wide resection margins to reduce recurrence rates.

126 patients with an R0 resection treated with hepatic surgery for intrahepatic cholangiocarcinoma at the Surgical Department at the Medical University Centre Essen, Germany were identified in a database and retrospectively analysed. Patients were grouped into three groups according to margin width, <1 mm (very narrow margin width) 1–5 mm (narrow margin width) and >5 mm (wide margin width). Epidemiological as well as perioperative data was analysed, and a univariate analysis as well as Kaplan-Meier plots carried out to investigate recurrence-free and overall survival.

Wider resection margins did not lead to better recurrence-free survival.

A wider resection margin >5 mm was not significantly associated with improved overall survival.

Positive lymph nodes (HR 2.50, 95% CI 1.11–5.61, p=0.027) and non-anatomic resections (HR 2.06, 95% CI 1.13–3.75, p=0.019) are significantly associated with poorer overall survival. Regarding recurrence-free survival, V2 vascular invasion was the only risk factor statistically significantly associated with poorer recurrence-free survival (HR 8.83, 95% CI 0.85–2.83, p=0.005).

Resection margins did not have a significant impact on disease free survival or overall survival following hepatic resection for intrahepatic cholangiocarcinoma. Non-anatomical resections, lymph node and vascular invasion all significantly impacted oncological outcomes.

Cholangiocarcinoma (CCA) is a common malignant tumor of the biliary tract that carries a high burden of morbidity and a poor prognosis. Due to the lack of precise diagnostic methods, many patients are often diagnosed at advanced stages of the disease. The current treatment options available are of varying efficacy, underscoring the urgency for the discovery of more effective biomarkers for early diagnosis and improved treatment. Recently, single-cell sequencing (SCS) technology has gained popularity in cancer research. This technology has the ability to analyze tumor tissues at the single-cell level, thus providing insights into the genomics and epigenetics of tumor cells. It also serves as a practical approach to study the mechanisms of cancer progression and to explore therapeutic strategies. In this review, we aim to assess the heterogeneity of CCA using single-cell sequencing technology, with the ultimate goal of identifying possible biomarkers and potential treatment targets.

This chapter presents a comprehensive approach to primary liver tumours as per the World Health Organization Classification of Liver Tumours 2019. The discussions include clinical features, aetiology and treatment summaries, as well as detailed gross pathology, histopathology and the use of up-to-date immunohistochemistry and molecular pathology in the diagnosis. Cytopathologic features, emphasizing fine-needle aspiration diagnosis, are also included. Numerous detailed tables and photographs of liver lesions highlight important diagnostic features. The immunohistochemical approach to aid in the identification of metastatic versus primary liver tumours is also discussed.

Cholangiocarcinoma (CCA) refers to cancers that arise from biliary epithelium. These tumors can occur anywhere along the biliary tree and are divided into extrahepatic cholangiocarcinoma (ECC) and intrahepatic cholangio (ICC), with ECC lesions subclassified into peri and distal lesions. This practical classification is based on anatomy and surgical management. Cancers of the gallbladder (GB) are part of the CCA family, but have a different clinical presentation and therapeutic approach. In this chapter, we present the epidemiology, clinical presentation, anatomy, pathology, staging, pattern of spread, treatment, recommendations for surveillance, and recommendations for a complete radiologic report of patients with CCA. The chapter is divided into sections corresponding to ICC and ECC, and gallbladder cancer (GB CA).

Cholangiocarcinoma (CCA) is a malignancy of the bile ducts with a rising incidence and high mortality. CCA often presents with advanced disease limiting the possibility of curative resection and/or liver transplantation. Alleviating biliary obstruction is a dominant component to improving outcomes, which can be achieved with effective mechanical decompression combined with ablative treatments including photodynamic therapy (PDT), radiofrequency ablation (RFA) and intraluminal brachytherapy (ILBT). The goals for most patients are to mitigate the effects of biliary obstruction and complications of jaundice, cholangitis and liver failure, factors that are associated with decreased quality of life and shortened survival. Therapeutic decisions are made with attention to the extent and location of disease, intent of therapy, and individual patient considerations. PDT involves systemic infusion of a photosensitizer chemical which is preferentially taken up by neoplastic tissue followed by exposure to laser resulting in targeted cell death. PDT in conjunction with stenting improves overall survival and stent patency. Notable risks include photosensitivity, cholangitis, liver abscess, and hemobilia. RFA uses high frequency alternating current to produce heat leading to local ablation with coagulative necrosis of tissue adjacent to the RFA probe. Limited data show improved stent patency and overall survival with a reasonable safety profile. There are limited data on intraluminal brachytherapy which highlight its role in improving survival by delivering high dose local radiation therapy most commonly as part of a neoadjuvant strategy for liver transplantation in select patients with CCA. For such patients the endoscopic approach may reduce risk of tumor seeding compared to transcutaneous approach.