Loveday Benjamin P T, Knox Jennifer J, Dawson Laura A, Metser Ur, Brade Anthony, Horgan Anne M, Gallinger Steven, Greig Paul D, Moulton Carol-Anne
Department of Surgery, Toronto General Hospital, Ontario, Canada.
Department of Medical Oncology, Princess Margaret Cancer Centre (PMCC), Ontario, Canada.
J Surg Oncol. 2018 Feb;117(2):213-219. doi: 10.1002/jso.24833.
Neoadjuvant chemoradiation and liver transplantation may be offered for unresectable perihilar cholangiocarcinoma (pCCA). This study aimed to determine the dropout rate and survival of patients who entered a national tri-modality protocol.
Patients enrolled Jan 2009-Aug 2015 were included. Enrolment criteria: ≤65 years, brush biopsy-proven unresectable pCCA <3.5 cm diameter. Conformal radiotherapy was given concurrently with Capecitabine. Following surgical staging, patients received maintenance Cisplatin and Gemcitabine until transplant or progression. Time to event analyses were performed from start of neoadjuvant therapy.
Of 43 patients screened, 18 started treatment; median age 53.9 (26.7-62.8) years, tumour diameter 2.7 (2.0-3.4) cm. 11/18 dropped out due to metastatic disease identified during chemoradiation (n = 2), surgical staging (n = 6), or maintenance chemotherapy (n = 3). Six patients underwent transplantation. Median follow up was 17.6 (4.9-57.7) months and overall survival 16.4 months. One and two year survival was 70.6% and 35.3%, respectively. One and 2 year post transplant survival was 83.3% and 55.6%. Median progression free survival was 11.5 months.
Neoadjuvant chemoradiation and liver transplantation for unresectable early stage pCCA is feasible, although with high rates of dropout and disease progression. Further research is required to determine factors to help select patients for treatment.
对于无法切除的肝门部胆管癌（pCCA），可采用新辅助放化疗和肝移植治疗。本研究旨在确定进入全国三联治疗方案的患者的退出率和生存率。
纳入2009年1月至2015年8月登记的患者。纳入标准：年龄≤65岁，经刷检活检证实为无法切除的pCCA，直径<3.5厘米。调强适形放疗与卡培他滨同步进行。手术分期后，患者接受顺铂和吉西他滨维持治疗，直至移植或病情进展。从新辅助治疗开始进行事件发生时间分析。
在43例筛查患者中，18例开始治疗；中位年龄53.9（26.7 - 62.8）岁，肿瘤直径2.7（2.0 - 3.4）厘米。18例中有11例因在放化疗期间（n = 2）、手术分期（n = 6）或维持化疗（n = 3）时发现转移性疾病而退出。6例患者接受了移植。中位随访时间为17.6（4.9 - 57.7）个月，总生存期为16.4个月。1年和2年生存率分别为70.6%和35.3%。移植后1年和2年生存率分别为83.3%和55.6%。中位无进展生存期为11.5个月。
对于无法切除的早期pCCA，新辅助放化疗和肝移植是可行的，尽管退出率和疾病进展率较高。需要进一步研究以确定有助于选择治疗患者的因素。
