PDF(Pubmed)
Abstract：
Cholangiocarcinomas (CCAs) are a subclass of biliary tract tumors that arise from the epithelial lining of bile ducts. They are subdivided broadly into intra- and extrahepatic CCA, with extrahepatic being the more common. Circulating tumor DNA (ctDNA) is a form of liquid biopsy obtained from dying tumor cells in the peripheral blood. Assays may be tumor-informed or tumor-agnostic, with the former requiring tissue sampling to evaluate detectable mutations present in an individual patient\'s tumor. Here we present a case of intrahepatic CCA managed with hepatectomy followed by adjuvant chemotherapy, with subsequent surveillance and management guided by tumor-informed ctDNA. A 79-year-old female presented to our hospital in December 2019 with three months of postprandial epigastric abdominal pain. Computed tomography (CT) revealed a 5.7 x 5.2 cm left hepatic lobe mass, and surgical pathology confirmed invasive CCA. She underwent left hepatectomy with hepaticojejunostomy one month after presentation and started adjuvant chemotherapy thereafter. She followed us to our cancer center for standard surveillance along with ctDNA. Her tumor markers were within normal limits, and ctDNA was negative until May 2022, when ctDNA was detected, while CA 19-9 remained normal; CT imaging was without evidence of disease. Positron emission tomography-computed tomography (PET-CT) performed in July 2022 revealed local recurrence at the surgical margin, which was confirmed by an endoscopic biopsy. She began gemcitabine-capecitabine chemotherapy in October 2022, completed four cycles followed by chemoradiation therapy, and is currently at her baseline functional status with no detectable radiologic or molecular evidence of disease.
摘要：
胆管癌（CCAs）是胆管上皮内膜引起的胆道肿瘤的一个亚类。它们被广泛细分为肝内和肝外CCA，肝外更为常见。循环肿瘤DNA（ctDNA）是一种从外周血中垂死的肿瘤细胞获得的液体活检形式。分析可能是肿瘤知情或肿瘤不可知的，前者需要组织取样来评估个体患者肿瘤中存在的可检测突变。在这里，我们提出了一例肝内CCA管理肝切除术后辅助化疗，随后的监测和管理由肿瘤知情的ctDNA指导。一名79岁女性于2019年12月到我院就诊，出现三个月的餐后上腹部腹痛。计算机断层扫描（CT）显示5.7x5.2cm左肝叶肿块，手术病理证实有侵袭性CCA。就诊后一个月，她接受了肝空肠吻合术的左肝切除术，此后开始辅助化疗。她跟着我们到我们的癌症中心进行标准监测和ctDNA。她的肿瘤标志物在正常范围内，ctDNA是阴性的，直到2022年5月，当ctDNA被检测到时，而CA19-9保持正常；CT成像没有疾病证据。2022年7月进行的正电子发射断层扫描（PET-CT）显示手术边缘局部复发，经内镜活检证实.她于2022年10月开始吉西他滨-卡培他滨化疗，完成了四个周期，随后进行了放化疗。目前处于基线功能状态，没有可检测到的放射学或分子疾病证据。
