J Natl Compr Canc Netw. 2018 Oct;16(10):1193-1199. doi: 10.6004/jnccn.2018.7053.
Combined hepatocellular-cholangiocarcinoma tumors (cHCC-CCA) are a heterogeneous group of rare malignancies that have no established optimal treatment. We identified patients with cHCC-CCA treated at a tertiary center and retrospectively examined their histology, interventions, and outcomes. We calculated disease control rate (DCR), disease progression, overall survival, and progression-free survival (PFS) between treatment subgroups. A total of 123 patients were evaluable. Interventions included resection, locoregional therapy, transplant, chemotherapy, and targeted agents. Ultimately, 68 patients received systemic treatment-57 with gemcitabine plus either 5-fluoropyrimidine (5-FU) or a platinum combination. Disease progression was more common in the gemcitabine/5-FU group versus gemcitabine/platinum (=.028), whereas DCR favored gemcitabine/platinum (78.4% vs 38.5%; =.0143). Median PFS from time of initial diagnosis favored the gemcitabine/platinum group, but the difference did not reach statistical significance. Targeted agents had minimal to no effect on survival metrics. Gemcitabine/platinum seems to be a superior regimen for patients with cHCC-CCA who require systemic treatment. Further studies are needed to clarify the regimen's efficacy and applicability in patient subgroups.
混合型肝细胞癌-胆管细胞癌（cHCC-CCA）是一组罕见的异质性恶性肿瘤，目前尚无确定的最佳治疗方法。我们在一家三级中心确定了接受治疗的 cHCC-CCA 患者，并回顾性地检查了他们的组织学、干预措施和结果。我们计算了治疗亚组之间的疾病控制率（DCR）、疾病进展、总生存期和无进展生存期（PFS）。共有 123 名患者可评估。干预措施包括切除术、局部区域治疗、移植、化疗和靶向药物治疗。最终，68 名患者接受了系统治疗-57 名患者接受了吉西他滨加氟尿嘧啶（5-FU）或铂类联合治疗。吉西他滨/5-FU 组的疾病进展更为常见（=.028），而 DCR 则有利于吉西他滨/铂类（78.4% vs 38.5%；=.0143）。从初始诊断开始，吉西他滨/铂类组的中位 PFS 更有利，但差异无统计学意义。靶向药物对生存指标的影响最小。对于需要系统治疗的 cHCC-CCA 患者，吉西他滨/铂类似乎是一种更好的治疗方案。需要进一步的研究来阐明该方案在患者亚组中的疗效和适用性。
