Yang Ziyi, Wu Ziyou, Xiong Yichen, Liu Shilei, Cai Chen, Shao Ziyu, Zhu Yidi, Song Xiaoling, Shen Wei, Wang Xuefeng, Wu Xiangsong, Gong Wei
Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai, China.
Front Oncol. 2022 Aug 16;12:977963. doi: 10.3389/fonc.2022.977963. eCollection 2022.
Gallbladder cancer (GBC) is highly malignant and is often diagnosed at the advanced stage. Lack of opportunity to surgery results in an unsatisfactory outcome. This pilot study employed gemcitabine combined with nab-paclitaxel (AG) as a conversion therapeutic measure for locally advanced GBC and successfully achieved conversion surgery in three initially unresectable GBC patients. We will introduce our experience on improving the outcome of this dismal disease.
Radiology and nuclear medicine imaging were performed in each patient, and resectability was evaluated by joint consultation of our multi-disciplinary team (MDT). Patients evaluated as unresectable were treated with the AG regimen and re-evaluated for treatment response. When complete or partial response is achieved, MDT opinion would be required to assess the possibility of performing conversion surgery with R0 resection.
Three GBC patients who were initially evaluated as unresectable successfully underwent R0 resection after conversion therapy with the AG regimen. The first case was a recurrent GBC patient evaluated as locally advanced and eventually achieved pathological complete response. The second case was a GBC patient who underwent R1 resection with residual lesions in the gallbladder bed and isolated No. 16 lymph node metastasis and who had a pathologically complete response after treatment. The third case had multiple but resectable liver metastases; both objective response and partial pathologic response were achieved. None of the patients experienced serious treatment-related adverse events. All cases revealed no evidence of recurrence or metastasis after a median follow-up of 12 months.
Conversion therapy shows a favorable efficacy in those unresectable GBC patients. Gemcitabine plus nab-paclitaxel has the potential to be used as a preoperative treatment option for GBC patients at the advanced stage. To further explore the efficacy of AG on conversion therapy for GBC patients, a prospective clinical trial has been registered (ChiCTR2200055698).
胆囊癌（GBC）恶性程度高，常于晚期被诊断出来。缺乏手术机会导致治疗效果不理想。本前瞻性研究采用吉西他滨联合白蛋白结合型紫杉醇（AG）作为局部晚期GBC的转化治疗措施，并成功使3例最初无法切除的GBC患者实现了转化手术。我们将介绍我们在改善这种预后不佳疾病的治疗效果方面的经验。
对每位患者进行放射学和核医学成像检查，并通过我们的多学科团队（MDT）联合会诊评估可切除性。被评估为不可切除的患者接受AG方案治疗，并重新评估治疗反应。当达到完全或部分缓解时，需要MDT的意见来评估进行R0切除转化手术的可能性。
3例最初被评估为不可切除的GBC患者在接受AG方案转化治疗后成功接受了R0切除。第一例是一名复发性GBC患者，被评估为局部晚期，最终实现了病理完全缓解。第二例是一名GBC患者，在胆囊床有残留病变且有孤立的16号淋巴结转移，接受了R1切除，治疗后实现了病理完全缓解。第三例有多个但可切除的肝转移灶；实现了客观缓解和部分病理缓解。所有患者均未发生严重的治疗相关不良事件。所有病例在中位随访12个月后均未发现复发或转移迹象。
转化治疗在那些不可切除的GBC患者中显示出良好的疗效。吉西他滨加白蛋白结合型紫杉醇有潜力作为晚期GBC患者的术前治疗选择。为进一步探索AG对GBC患者转化治疗的疗效，一项前瞻性临床试验已注册（ChiCTR2200055698）。
