Araki Tatsuhiro, Muranushi Ryo, Takagi Kohji, Tanaka Haruyoshi, Shibuya Kazuto, Ando Takayuki, Yoshioka Isaku, Hirabayashi Kenichi, Yasuda Ichiro, Fujii Tsutomu
Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Toyama, Sugitani, 930-0194, Japan.
Department of Diagnostic Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630, Toyama, Sugitani, 930-0194, Japan.
Clin J Gastroenterol. 2025 Feb;18(1):161-168. doi: 10.1007/s12328-024-02053-3. Epub 2024 Oct 22.
We report a rare case of a patient with initially unresectable gallbladder cancer who underwent conversion surgery with durvalumab in combination with gemcitabine plus cisplatin and achieved an R0 resection. A 68 year-old woman was found to have gallbladder cancer and multiple enlarged lymph nodes around the suprapancreatic rim and hepatic hilum invading the proper hepatic artery on computed tomography. The diagnosis was cT3cN2cM0, cStage IVB. After eight cycles of durvalumab in combination with gemcitabine plus cisplatin, all tumor markers became negative, and lymph node invasion of the hepatic artery disappeared. The patient underwent conversion surgery with gallbladder bed resection and regional lymph node dissection. There was no need for hepatic artery reconstruction. Pathology revealed ypT2aypN0ycM0, ypStage IIA, and radical resection was considered. Immunostaining of tissue collected at the time of endoscopic ultrasound-guided tissue acquisition revealed less than 1% programmed death ligand-1 expression. The patient continued adjuvant chemotherapy with single-agent durvalumab every 4 weeks and maintained a relapse-free survival of 8 months postoperatively. The utility of durvalumab in combination with gemcitabine plus cisplatin in unresectable gallbladder cancer independent of programmed death ligand-1 expression has been confirmed and may be an important option in future multimodal treatment, including conversion surgery.
我们报告了一例罕见的初始不可切除胆囊癌患者，该患者接受了度伐利尤单抗联合吉西他滨加顺铂的转化手术，并实现了R0切除。一名68岁女性经计算机断层扫描发现患有胆囊癌，胰上缘和肝门周围有多个肿大淋巴结，侵犯了肝固有动脉。诊断为cT3cN2cM0，c期IVB。在接受度伐利尤单抗联合吉西他滨加顺铂的八个周期治疗后，所有肿瘤标志物均转为阴性，肝动脉的淋巴结侵犯消失。患者接受了胆囊床切除和区域淋巴结清扫的转化手术。无需进行肝动脉重建。病理显示为ypT2aypN0ycM0，yp期IIA，考虑为根治性切除。在内镜超声引导下组织获取时收集的组织免疫染色显示程序性死亡配体-1表达低于1%。患者每4周继续接受单药度伐利尤单抗辅助化疗，术后无复发生存期维持了8个月。已证实度伐利尤单抗联合吉西他滨加顺铂在不可切除胆囊癌中的应用与程序性死亡配体-1表达无关，可能是未来多模式治疗（包括转化手术）中的一个重要选择。
