胆管癌的化疗现状

Chemotherapy for cholangiocarcinoma

胆管癌是一种较少见的恶性肿瘤,其预后差,死亡率高。对于某些经选择的患者,外科切除是唯一的治愈方法。目前,尚缺乏有指导意义的术后辅助化疗的研究。初步数据显示部分经新辅助放化疗的患者,可通过肝移植延长生存期。对于已经处于局部晚期或远处转移的患者的治疗,有一些小型、非随机的Ⅱ期试验,部分试验的入组患者不仅有胆管癌,还包括胆囊癌、胰腺癌和肝细胞肝癌。对于晚期胆管癌,试验常选择吉西他滨、顺铂或氟尿嘧啶进行治疗,但不论单药还是联合用药,其效果均很微弱,并且疗效不持久,故尚无标准治疗。

Cholangiocarcinoma is a rare malignancy associated with poor prognosis and high mortality. Surgical resection is the only chance for cure depending on careful patient selection. There are no well-conducted studies regarding the role of adjuvant chemotherapy. Preliminary data suggests that liver transplantation could offer long-term survival in selected patients when combined with neoadjuvant chemoradiotherapy. In patients with locally advanced or metastatic disease, most studies are small, non-randomized phase Ⅱ trials, and many studies comprise a mix of bile duct cancers, gallbladder cancer, and either pancreatic or hepatoeellular cancers. In advanced cancer, phase Ⅱ studies with several cytotoxics, including gemcitabine, the platinums, and the fluoropyrimidines, have shown a modest and often short-lasting activity. No single chemotherapy agent or combination regimen can therefore be recommended as a standard of care at present.