Cholangiocarcinoma (CCA) is a fatal malignancy with steadily increasing incidence and poor prognosis. Since most CCA cases are diagnosed at an advanced stage, systemic therapies, including chemotherapy, radiotherapy, targeted therapy, and immunotherapy, play a crucial role in the management of unresectable CCA. The recent advances in targeted therapies and immunotherapies brought more options in the clinical management of unresectable CCA. This review depicts the advances of targeted therapies and immunotherapies for unresectable CCA, summarizes crucial clinical trials, and describes the efficacy and safety of different drugs, which may help further develop precision and individualization in the clinical treatment of unresectable CCA.
Humans ; Cholangiocarcinoma/drug therapy* ; Immunotherapy/methods* ; Bile Duct Neoplasms/drug therapy* ; Molecular Targeted Therapy/methods*

Objective To investigate the characteristics of multislice spiral CT in solitary pulmonary mucinous adenocarcinoma and its relationship with pathology. Methods The clinical data, CT characteristics and pathological features of 16 patients with solitary pulmonary mucinous adenocarcinoma confirmed by pathology from March 2010 to May 2018 were analyzed, and the number, distribution, size, shape, boundary, density, adjacent structure changes and intensifying performance were observed and compared with pathological results. Results The single lesion was distributed in the lung lobe in 16 cases, in the lower lobe in 13 cases, in the middle lobe in 1 case, and in the upper lobe in 2 cases, of which 12 cases were located under the pleura. There were 2 cases of central type and 14 cases of peripheral type. The longest diameter of tumor was 1.2- 3.0 cm, with an average of (2.1 ± 0.9) cm. Eleven lesions were round or approximately round, 5 lesions were irregular, 8 lesions had clear boundary, 6 lesions had irregular boundary and burr sign, 12 lesions had shallow or deep lobulation, 2 lesions had small vacuoles and 2 lesions had vascular aggregation. Multislice spiral CT plain scan showed that the density of lesions was lower than that of the same level muscle density. Enhanced scanning showed mild to moderate homogeneous or heterogeneous enhancement. Microscopic examination revealed that the cytoplasm of tumor cells contained large amounts of mucus and mucus was fluid. Most of the tumor cells were attached to the cell wall. Some of the tumor cells were floating in mucus and flowing with mucus. Conclusions If the tumor distribution and morphology is associated with the gravity factor, the enhanced scan is stripe like, and there is no invasion of the pleural, no pleural effusion and no metastasis when the tumor is large, and the solitary pulmonary mucinous adenocarcinoma should be highly suspected.

Objective To evaluate the value of transrectal real-time tissue elastography (TRTE) combined with multi parameter magnetic resonance imaging (MRI) in prostate biopsy.Methods One hundred and five patients of suspected prostate cancer patients were treated from December 2013 to December 2015 in Jiaxing Traditional Chinese Medicine Hospital. All the patients were confirmed by operation and pathology. Transrectal ultrasonography guided biopsy was performed in 105 patients after TRTE and MRI examinations, respectively, including routine 6 point needle biopsy and targeted biopsy of the positive area. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TRTE, MRI and TRTE combined with MRI guided biopsy in the diagnosis of prostate cancer were evaluated with the results of operation and pathology as the gold standard.Results Surgical pathology confirmed that there were 44 benign prostatic nodules and 61 cases of prostate cancer in 105 cases. Fifty-two cases of prostate cancer was diagnosed by TRTE, and 45 cases were confirmed by operation and pathology. Fifty-six cases of prostate cancer was diagnosed by MRI, and 48 cases were confirmed by operation and pathology. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of diagnosing prostate cancer by TRTE, MRI and TRTE combined with MRI guided percutaneous biopsy were 71.4％, 84.0％, 78.0％, 0.865, 0.698, 78.6％, 81.8％, 80.0％, 0.857, 0.734, 90.1％, 88.6％, 89.5％,0. 916 and 0.866. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of diagnosing prostate cancer by TRTE combined with MRI guided biopsy were higher than those of TRTE and MRI. Conclusions Both TRTE and MRI have their respective advantages. The accurate localization before puncture is helpful to develop individualized program for prostate puncture, and the combining use of the two methods can improve the detection rate of prostate cancer.