Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK.
Hepatobiliary Pancreat Dis Int. 2020 Apr;19(2):103-108. doi: 10.1016/j.hbpd.2020.02.007. Epub 2020 Feb 20.
Treatment with neoadjuvant chemoradiotherapy followed by liver transplantation yields promising results in perihilar cholangiocarcinoma (PH-CCA). This study reviews the literature to assess whether there is evidence to justify modern phase II studies of neoadjuvant chemoradiotherapy prior to resection of PH-CCA.
A systematic review of the literature for reports of patients undergoing resection of PH-CCA after neoadjuvant chemoradiotherapy was performed using MEDLINE and EMBASE databases for the period between 1990 and 2019. The keywords and MeSH headings "hilar cholangiocarcinoma", "Klatskin", "chemoradiotherapy" and "chemotherapy" were used. Data were extracted on demographic profile, disease staging, chemoradiotherapy protocols, complications and outcome. Risks of bias were assessed using Cochrane methodology.
There were seven reports on this topic, with median recruitment period of 14 (range 4-31) years. The total number of patients in these studies was 87. Interval from completion of neoadjuvant treatment to surgery varied from 3 days to 6 months. Resection was by hepatectomy with three studies reporting an R0 rate of 100%, 24% and 63%, respectively. Three studies reported histopathological evidence of prior treatment response. There were two treatment related deaths at 90 days. Median survival was 19 (95% CI: 9.9-28) months and 5-year survival 20%.
There are potential benefits of treatment on both R0 rate and complete response in resected specimens. Scientific equipoise exists in relation to neoadjuvant chemoradiotherapy for PH-CCA.
新辅助放化疗联合肝移植治疗肝门部胆管癌（PH-CCA）疗效显著。本研究对相关文献进行系统回顾，以评估 PH-CCA 患者行新辅助放化疗后行切除术是否有开展现代 II 期研究的证据。
通过 MEDLINE 和 EMBASE 数据库，对 1990 年至 2019 年间发表的新辅助放化疗后行 PH-CCA 切除术患者的文献进行系统回顾，使用的关键词和 MeSH 主题词包括“肝门部胆管癌”“Klatskin”“放化疗”和“化疗”。提取的资料包括人口统计学特征、疾病分期、放化疗方案、并发症和结局。使用 Cochrane 方法评估偏倚风险。
共有 7 篇关于该主题的报告，中位招募期为 14 年（范围 4-31 年）。这些研究的患者总数为 87 例。新辅助治疗完成至手术的间隔时间为 3 天至 6 个月。手术方式均为肝切除术，其中 3 项研究的 R0 切除率分别为 100%、24%和 63%。3 项研究报告了组织病理学证据表明治疗前有反应。有 2 例与治疗相关的 90 天死亡。中位总生存期为 19 个月（95%CI：9.9-28），5 年生存率为 20%。
新辅助放化疗在 R0 切除率和切除标本完全缓解方面可能有获益。PH-CCA 行新辅助放化疗存在科学不确定性。
