Prasad Ganapathy A, Wang Kenneth K, Baron Todd H, Buttar Navtej S, Wongkeesong Louis-Michel, Roberts Lewis R, LeRoy Andrew J, Lutzke Lori S, Borkenhagen Lynn S
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Clin Gastroenterol Hepatol. 2007 Jun;5(6):743-8. doi: 10.1016/j.cgh.2007.02.021.
BACKGROUND & AIMS: Recent studies have shown a survival advantage using photodynamic therapy (PDT) in patients with unresectable cholangiocarcinoma. Factors associated with increased survival after PDT are unknown.
Twenty-five patients with cholangiocarcinoma who were treated with PDT at the Mayo Clinic Rochester from 1991 to 2004 were studied. Porfimer sodium (2 mg/kg) was administered intravenously to patients with Bismuth type I (3 patients), type III a/b (13 patients), and type IV (9 patients) tumors. Forty-eight hours later, PDT was administered using a 1.5- to 2.5-cm diffusing fiber that was advanced across the tumor by either retrograde (20 patients) or percutaneous (5 patients) cholangiography. Laser light was applied for a total energy of 180 J/cm2 in 1-3 applications. Patients received PDT treatments every 3 months. Plastic biliary stents (10-11.5 F) were inserted to decompress the biliary system after PDT. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards models.
Patients were 64 (standard error of the mean, +/-2.6) years of age; 20 (80%) were men. The median overall survival period was 344 days. The median survival period after PDT was 214 days. The 1-year survival rate was 30%. On multivariate analysis, the presence of a visible mass on imaging studies (hazard ratio, 3.55; 95% confidence interval, 1.21-10.38), and increasing time between diagnosis and PDT (hazard ratio, 1.13; 95% confidence interval, 1.02-1.25) predicted a poorer survival rate after PDT. A higher serum albumin level (hazard ratio, 0.16; 95% confidence interval, 0.04-0.59) predicted a lower mortality rate after PDT.
Patients with unresectable cholangiocarcinoma without a visible mass may benefit from earlier treatment with PDT.
近期研究表明，光动力疗法（PDT）可使无法切除的胆管癌患者获得生存优势。与PDT后生存率提高相关的因素尚不清楚。
对1991年至2004年在罗切斯特梅奥诊所接受PDT治疗的25例胆管癌患者进行研究。对铋分型为I型（3例）、III a/b型（13例）和IV型（9例）肿瘤的患者静脉注射卟吩姆钠（2mg/kg）。48小时后，使用1.5至2.5厘米的扩散光纤通过逆行胆管造影（20例患者）或经皮胆管造影（5例患者）推进穿过肿瘤进行PDT治疗。分1 - 3次施加激光，总能量为180 J/cm²。患者每3个月接受一次PDT治疗。PDT后插入塑料胆道支架（10 - 11.5F）以减压胆道系统。使用Kaplan - Meier曲线和Cox比例风险模型进行生存分析。
患者年龄为64岁（平均标准误差，±2.6）；20例（80%）为男性。总体中位生存期为344天。PDT后的中位生存期为214天。1年生存率为30%。多因素分析显示，影像学检查可见肿块（风险比，3.55；95%置信区间，1.21 - 10.38）以及诊断与PDT之间时间间隔增加（风险比，1.13；95%置信区间，1.02 - 1.25）预示PDT后生存率较低。血清白蛋白水平较高（风险比，0.16；95%置信区间，0.04 - 0.59）预示PDT后死亡率较低。
无可见肿块的无法切除胆管癌患者可能从早期PDT治疗中获益。
