Müller Bettina G, De Aretxabala Xabier, González Domingo Manuel
From the Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile; the Department of Surgery, Clínica Alemana de Santiago, Santiago, Chile; the Department of Radiotherapy, Instituto Oncológico, Viña del Mar, Chile.
Am Soc Clin Oncol Educ Book. 2014:e165-70. doi: 10.14694/EdBook_AM.2014.34.e165.
Gallbladder cancer is now considered a distinct clinical entity, allowing for a separate analysis from that of other malignancies of the biliary tree. Symptoms related to a malignant tumor of the gallbladder include jaundice and abdominal pain, or a palpable abdominal mass that occurs in a late stage of the disease. The majority of patients with operable gallbladder cancer are diagnosed by cholecystectomy performed for presumed benign disease, mostly cholelithiasis, a clinical entity known as incidental gallbladder cancer. Given the poor prognosis if tumor invasion beyond the muscular layer and/or nodal metastasis is found, adjuvant treatments have been implemented, but few data are available to guide treatment decisions in this setting. For advanced disease, a multidisciplinary treatment approach including biliary drainage procedures and palliative support is needed in the management of this aggressive disease. Palliative chemotherapy with a combination of gemcitabine and cisplatin or oxaliplatin is the standard treatment based on the findings of two phase III trials that showed improved overall survival compared to single-agent chemotherapy and best supportive care. Several phase II studies have been reported investigating the role of targeted agents against EGFR, VEGF, HER2, and MEK. International collaboration to enhance our knowledge of gallbladder cancer should be encouraged.
胆囊癌现在被视为一种独特的临床实体，因此可以与胆管树的其他恶性肿瘤分开进行分析。与胆囊恶性肿瘤相关的症状包括黄疸、腹痛，或在疾病晚期出现的可触及的腹部肿块。大多数可手术切除的胆囊癌患者是在因假定为良性疾病（主要是胆石症）而进行胆囊切除术时被诊断出来的，这一临床情况被称为意外胆囊癌。鉴于如果发现肿瘤侵犯超过肌层和/或出现淋巴结转移则预后较差，因此已经实施了辅助治疗，但在这种情况下几乎没有数据可用于指导治疗决策。对于晚期疾病，在这种侵袭性疾病的管理中需要采用包括胆管引流程序和姑息支持在内的多学科治疗方法。基于两项III期试验的结果，吉西他滨与顺铂或奥沙利铂联合的姑息化疗是标准治疗，这两项试验表明与单药化疗和最佳支持治疗相比，总体生存率有所提高。已经报道了几项II期研究，探讨了针对表皮生长因子受体（EGFR）、血管内皮生长因子（VEGF）、人表皮生长因子受体2（HER2）和丝裂原活化蛋白激酶（MEK）的靶向药物的作用。应鼓励开展国际合作以增进我们对胆囊癌的了解。
