Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.
Front Immunol. 2024 Jul 8;15:1433235. doi: 10.3389/fimmu.2024.1433235. eCollection 2024.
Periampullary carcinoma is a malignant gastrointestinal tumor originating from the head of the pancreas, distal bile duct, duodenum, or the ampulla of Vater. Currently, surgery remains the primary treatment option, yet the postoperative recurrence rate remains high. Chemotherapy is the main approach for controlling postoperative recurrence. Histologically, periampullary carcinoma is categorized into two types: intestinal (IN) and pancreaticobiliary (PB) subtype. Each subtype requires different therapeutic approaches, with the PB type primarily treated with gemcitabine and the IN type with 5-FU. Despite these options, patient outcomes are still unsatisfactory. In recent years, the feasibility of immunotherapy in tumor treatment has been increasingly evidenced, although research on its efficacy in periampullary carcinoma treatment is still limited. In this report, we present a case of a periampullary carcinoma patient who experienced recurrence and metastasis after undergoing radical pancreatoduodenectomy and receiving gemcitabine-based chemotherapy post-surgery. Through next-generation sequencing (NGS), we identified high expression levels of programmed cell death-ligand 1 (PD-L1) with a combined positive score (CPS) of 35, high tumor mutation burden (TMB-H), and high microsatellite instability (MSI-H) in this patient. Therefore, we implemented a combination therapy using Tislelizumab and chemotherapy. According to the latest follow-up, the tumors are effectively controlled. Our utilization of immunotherapy combined with chemotherapy holds significant implication for the treatment of periampullary carcinoma.
壶腹周围癌是一种起源于胰腺头部、远端胆管、十二指肠或 Vater 壶腹的恶性胃肠道肿瘤。目前，手术仍然是主要的治疗选择，但术后复发率仍然很高。化疗是控制术后复发的主要方法。壶腹周围癌在组织学上可分为两种类型：肠型（IN）和胰胆管型（PB）亚型。每种亚型需要不同的治疗方法，PB 型主要用吉西他滨治疗，IN 型用 5-FU 治疗。尽管有这些选择，患者的预后仍然不理想。近年来，免疫疗法在肿瘤治疗中的可行性越来越得到证实，尽管其在壶腹周围癌治疗中的疗效研究仍有限。在本报告中，我们介绍了一例壶腹周围癌患者，该患者在接受根治性胰十二指肠切除术和术后接受吉西他滨为基础的化疗后复发和转移。通过下一代测序（NGS），我们发现该患者的程序性细胞死亡配体 1（PD-L1）表达水平高，联合阳性评分（CPS）为 35，肿瘤突变负担高（TMB-H）和高度微卫星不稳定（MSI-H）。因此，我们采用Tislelizumab 联合化疗进行联合治疗。根据最新的随访结果，肿瘤得到有效控制。我们联合化疗使用免疫疗法对壶腹周围癌的治疗具有重要意义。
