吉西他滨联合铂类化疗治疗肝内胆管细胞癌的一线治疗：一项 AGEO 法国多中心回顾性研究。
Gemcitabine plus platinum-based chemotherapy for first-line treatment of hepatocholangiocarcinoma: an AGEO French multicentre retrospective study.
机构信息
Institut des Maladies de l'appareil Digestif, Nantes University Hospital, 1 place Alexis Ricordeau, Nantes 44000, France.
Department of Gastroenterology and Oncology, Cochin University Hospital, Paris 75014, France.
出版信息
Br J Cancer. 2018 Feb 6;118(3):325-330. doi: 10.1038/bjc.2017.413. Epub 2017 Nov 23.
BACKGROUND
Hepatocholangiocarcinoma (cHCC-ICC) is a rare liver tumour for which no data on chemosensitivity exist. The aims of this multicentre study were to evaluate overall survival (OS), progression-free survival (PFS), and prognostic factors in cHCC-ICC treated by gemcitabine plus platinum as first-line.
METHODS
Unresectable cHCC-ICC treated by gemcitabine plus platinum-based chemotherapy between 2008 and 2017 were retrospectively analysed. Diagnosis was based on histology or, in case of ICC or HCC histology, on discordant computerised tomography scan enhancement patterns associated with discordant serum tumour marker elevation suggesting the alternative tumour. OS and PFS were evaluated by Kaplan-Meier method and prognostic factors by Log-rank test and Cox model.
RESULTS
Among 30 patients included, cHCC-ICC was histologically proven in 22 (73.3%). 18 (60%) received gemcitabine plus oxaliplatin (GEMOX), 9 (30%) GEMOX plus bevacizumab, and 3 (10%) gemcitabine plus cisplatin. RECIST criteria were reported in 28 patients: 8 (28.6%) showed partial response, 14 (50%) stable disease, and 6 (21.4%) tumour progression at first evaluation. Median PFS and OS were 9.0 and 16.2 months, respectively. Serum bilirubin ⩾30 μmol l (P=0.001) and positive serology for HBV and/or HCV (P=0.014) were independent poor prognostic factors for OS.
CONCLUSIONS
Gemcitabine plus platinum-based chemotherapy is effective as first-line for advanced cHCC-ICC.
背景
肝内胆管细胞癌（cHCC-ICC）是一种罕见的肝脏肿瘤，目前尚无关于其化疗敏感性的数据。本多中心研究旨在评估吉西他滨联合铂类药物作为一线治疗不可切除 cHCC-ICC 的总生存期（OS）、无进展生存期（PFS）和预后因素。
方法
回顾性分析了 2008 年至 2017 年间接受吉西他滨联合铂类药物化疗的不可切除 cHCC-ICC 患者。根据组织学诊断，或 ICC 或 HCC 组织学，如果与计算机断层扫描增强模式不一致，且伴有血清肿瘤标志物升高提示另一种肿瘤，则诊断为 cHCC-ICC。采用 Kaplan-Meier 法评估 OS 和 PFS，Log-rank 检验和 Cox 模型评估预后因素。
结果
30 例患者中，22 例（73.3%）经组织学证实为 cHCC-ICC。18 例（60%）接受吉西他滨联合奥沙利铂（GEMOX）治疗，9 例（30%）接受 GEMOX 联合贝伐珠单抗治疗，3 例（10%）接受吉西他滨联合顺铂治疗。28 例患者报告了 RECIST 标准：首次评估时，8 例（28.6%）显示部分缓解，14 例（50%）为稳定疾病，6 例（21.4%）为肿瘤进展。中位 PFS 和 OS 分别为 9.0 个月和 16.2 个月。血清胆红素 ⩾30 μmol/L（P=0.001）和 HBV 和/或 HCV 血清学阳性（P=0.014）是 OS 的独立不良预后因素。
结论
吉西他滨联合铂类药物化疗作为晚期 cHCC-ICC 的一线治疗是有效的。
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