Shinchi H, Takao S, Nishida H, Aikou T
First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan.
J Surg Oncol. 2000 Oct;75(2):89-94. doi: 10.1002/1096-9098(200010)75:2<89::aid-jso3>3.0.co;2-v.
Hilar cholangiocarcinoma is a morbid disease with a poor prognosis because resection cannot be performed in many cases. The purpose of this study was to evaluate whether external beam radiotherapy (RT) combined with expandable metallic biliary stent (EMS) affects the length and quality of survival of patients with unresectable hilar cholangiocarcinomas.
Fifty-one patients with unresectable hilar cholangiocarcinoma were retrospectively reviewed. Thirty patients received external beam radiotherapy combined with EMS (EMS+RT group), 10 patients were treated with EMS alone (EMS group), and the remaining 11 patients underwent percutaneous transhepatic biliary drainage alone (PTBD group). The length and quality of survival were analyzed and compared among the three groups.
The mean survival of 6.4 months in the EMS group was significantly longer than that of 4.4 months in the PTBD group (P < 0.05). The EMS+RT group with a mean survival of 10.6 months had a significantly longer survival than the EMS group (P < 0.05). The average of the monthly Karnofsky scores of 74.9 in the EMS+RT group and 68.1 in the EMS group, as a parameter of quality of survival, was significantly higher than that of 57.7 in the PTBD group (P < 0.01). The number of hospital days per month of survival was significantly smaller in the EMS+RT and EMS groups than in the PTBD group (10.4, 14.2 vs. 27.3 days; P < 0.001). The EMS+RT group had a longer stent patency than the EMS group (mean: 9.8 vs. 3.7 months; P < 0.001).
These results indicate that external radiotherapy combined with metallic biliary endoprosthesis can increase the length and quality of survival and consequently provide a definite palliative benefit for patients with unresectable hilar cholangiocarcinoma.
肝门部胆管癌是一种预后较差的疾病，因为在许多情况下无法进行手术切除。本研究的目的是评估外照射放疗（RT）联合可扩张金属胆道支架（EMS）是否会影响不可切除肝门部胆管癌患者的生存时长和生存质量。
对51例不可切除肝门部胆管癌患者进行回顾性分析。30例患者接受外照射放疗联合EMS（EMS+RT组），10例患者仅接受EMS治疗（EMS组），其余11例患者仅接受经皮经肝胆道引流（PTBD组）。分析并比较三组患者的生存时长和生存质量。
EMS组的平均生存期为6.4个月，显著长于PTBD组的4.4个月（P<0.05）。EMS+RT组的平均生存期为10.6个月，其生存期显著长于EMS组（P<0.05）。作为生存质量参数，EMS+RT组的每月卡氏评分平均为74.9，EMS组为68.1，均显著高于PTBD组的57.7（P<0.01）。EMS+RT组和EMS组每月生存的住院天数显著少于PTBD组（分别为10.4天、14.2天和27.3天；P<0.001）。EMS+RT组的支架通畅时间长于EMS组（平均：9.8个月对3.7个月；P<0.001）。
这些结果表明，外照射放疗联合金属胆道内支架可延长不可切除肝门部胆管癌患者的生存时长和生存质量，从而为患者提供明确的姑息治疗益处。
