Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Gastroenterol Hepatol. 2013 Dec;28(12):1885-91. doi: 10.1111/jgh.12321.
Cholangiocarcinoma patients usually have poor treatment outcome and a high mortality rate. The role of adjuvant chemotherapy (AC) is controversial. Our study aimed to evaluate benefits of AC in resectable cholangiocarcinoma patients.
A retrospective study included 263 patients who underwent curative resection in Srinakarind University Hospital. These patients had pathological reports showing a clear margin (R0) or microscopic margin (R1) of lesion-free tissue.
There were 138 patients who received AC. This group had a significantly lower mean age than patients not receiving adjuvant chemotherapy (NAC) group (57.7 ± 8.5 vs 60.4 ± 9.0 years, P = 0.01). The level of serum albumin above 3 g/dL was more common in AC group than the NAC one (87.7% vs 79.2%, P = 0.04). Patients who received AC had significantly longer overall median survival time (21.6 vs 13.4 months, P = 0.01). Patients with a combination of gemcitabine and capecitabine regimen had the longest survival time (median overall survival time of gemcitabine and capecitabine 31.5, 5-fluorouracil and mitomycin 17.3, 5-fluorouracil alone 22.2, capecitabine alone 21.6, and gemcitabine alone 7.9 months, P = 0.02). Benefits of AC were likely to be found in patients who had high-risk features, that is, high level of carbohydrate antigen 19-9, advanced stage, T4 stage, lymph node involvement, and R1 margin.
AC significantly prolongs survival time in resectable cholangiocarcinoma patients, particularly in the high risk group.
胆管癌患者的治疗效果通常较差，死亡率较高。辅助化疗（AC）的作用存在争议。本研究旨在评估辅助化疗对可切除胆管癌患者的获益。
本回顾性研究纳入了 263 例在诗纳卡琳威洛大学医院接受根治性切除术的患者。这些患者的病理报告显示切缘无肿瘤（R0）或有镜下切缘（R1）的无病变组织。
有 138 例患者接受了 AC。与未接受辅助化疗（NAC）的患者相比，该组的平均年龄明显较低（57.7±8.5 岁 vs 60.4±9.0 岁，P=0.01）。血清白蛋白水平高于 3g/dL 的患者在 AC 组更为常见（87.7% vs 79.2%，P=0.04）。接受 AC 的患者中位总生存时间明显延长（21.6 个月 vs 13.4 个月，P=0.01）。接受吉西他滨联合卡培他滨方案治疗的患者生存时间最长（吉西他滨联合卡培他滨中位总生存时间为 31.5 个月，5-氟尿嘧啶联合丝裂霉素为 17.3 个月，5-氟尿嘧啶单药为 22.2 个月，卡培他滨单药为 21.6 个月，吉西他滨单药为 7.9 个月，P=0.02）。AC 的获益可能在具有高危特征的患者中更为明显，即高 CA19-9 水平、晚期、T4 期、淋巴结受累和 R1 切缘。
辅助化疗可显著延长可切除胆管癌患者的生存时间，特别是在高危组。
