Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2022; 10(27): 9743-9749
Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9743
Successful treatment of stage IIIB intrahepatic cholangiocarcinoma using neoadjuvant therapy with the PD-1 inhibitor camrelizumab: A case report
Shu-Guang Zhu, Hai-Bo Li, Tian-Xing Dai, Hua Li, Guo-Ying Wang
Shu-Guang Zhu, Hai-Bo Li, Tian-Xing Dai, Hua Li, Guo-Ying Wang, Department of Hepatic Surgery and Liver Transplantation, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Guo-Ying Wang, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510220, Guangdong Province, China
Author contributions: Zhu SG and Li HB contributed equally to this work; Wang GY and Li HB designed the research study; Zhu SG, Li HB, and Dai TX performed the research and wrote the manuscript; all authors have read and approved the final manuscript.
Supported by The National 13th Five-Year Science and Technology Plan Major Projects of China, No. 2017ZX10203205-006-001 and No. 2017ZX10203205-001-003.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Guo-Ying Wang, MD, PhD, Associate Professor, Chief Doctor, Director, Surgeon, Department of Hepatic Surgery and Liver Transplantation, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China.
Received: November 9, 2021
Peer-review started: November 9, 2021
First decision: December 27, 2021
Revised: January 24, 2022
Accepted: August 16, 2022
Article in press: August 16, 2022
Published online: September 26, 2022

The prognosis of intrahepatic cholangiocarcinoma (ICC) with lymph node metastasis is poor. The feasibility of surgery is not certain, which is a contraindication according to the National Comprehensive Cancer Network guidelines. The role of immunotherapy as a neoadjuvant therapy for ICC is not clear. We herein describe a case of ICC with lymph node metastasis that was successfully treated with neoadjuvant therapy.


A 60-year-old man with a liver tumor was admitted to our hospital. Enhanced computed tomography and magnetic resonance imaging revealed a space-occupying lesion in the right lobe of the liver. Multiple subfoci were found around the tumor, and the right posterior branch of the portal vein was invaded. Liver biopsy indicated poorly differentiated cholangiocytes. According to the American Joint Committee on Cancer disease stage classification, ICC with hilar lymph node metastasis (stage IIIB) and para-aortic lymph node metastasis was suspected. A report showed that two patients with stage IIIB ICC achieved a complete response (CR) 13 mo and 16 mo after chemotherapy with a PD-1 monoclonal antibody. After multidisciplinary consultation, the patient was given neoadjuvant therapy, surgical resection and lymph node dissection, and postoperative adjuvant therapy. After three rounds of PD-1 immunotherapy (camrelizumab) and two rounds of gemcitabine combined with cisplatin regimen chemotherapy, the tumor size was reduced. Therefore, a partial response was achieved. Exploratory laparotomy found that the lymph nodes of Group 16 were negative, and the tumor could be surgically removed. Therefore, the patient underwent right hemihepatectomy plus lymph node dissection. The patient received six rounds of chemotherapy and five rounds of PD-1 treatment postoperatively. After 8 mo of follow-up, no recurrence was found, and a CR was achieved.


Neoadjuvant therapy combined with surgical resection is useful for advanced-stage ICC. This is the first report of successful treatment of stage IIIB ICC using neoadjuvant therapy with a PD-1 inhibitor.

Keywords: Intrahepatic cholangiocarcinoma, Lymph node metastasis, Neoadjuvant therapy, Immunotherapy, Chemotherapy, Surgical resection, Case report

Core Tip: At present, the objective remission rate of intrahepatic cholangiocarcinoma (ICC) in the treatment of advanced hepatocellular carcinoma (HCC) patients is approximately 20%. The development of more sensitive and efficient predictive methods will improve the benefits of ICC therapy in potential patients with advanced HCC and benefit patients who are suitable for ICC therapy. This will hopefully open up a new prospect of immunotherapy for liver tumors. Immunotherapy may be a potential treatment option for ICC.