晚期胆系恶性肿瘤化疗方案的回顾性研究

Retrospective study on chemotherapy for advanced biliary tract carcinoma

目的:回顾性分析浙江大学医学院附属第一医院收治的91例晚期胆系恶性肿瘤患者的化疗疗效及影响因素。方法:收集浙江大学医学院附属第一医院2010年1月至2015年4月治疗的91例晚期胆系恶性肿瘤患者临床资料,分析患者的基础特征、治疗方案及疗效。结果:91例患者中男性56例,女性35例,中位年龄为57岁。共90例患者接受了一线化疗并且可以评价疗效,69例患者接受了GP方案,21例患者接受了其他方案,二者疾病控制率(disease control rate,DCR)为68.1%vs.52.4%;中位无进展生存期(median progression free survival,mPFS)为5.10个月vs.2.50个月(P=0.025);中位总生存期(median overall survival,mOS)为13.00个月vs.7.20个月。43例患者接受了二线化疗并且可以评价疗效,31例患者接受了S-1为基础的化疗方案,12例患者接受了非S-1为基础的化疗方案,DCR、mPFS、mOS差异均无统计学意义。4例患者接受了含贝伐珠单抗的二线治疗方案,其mPFS及mOS较其他方案均延长,但差异无统计学意义。血液学毒性为一线GP方案最常见的不良反应。S-1为基础的化疗方案不良反应较少。结论:对晚期胆系肿瘤患者来说,GP方案是有效的一线治疗方案,S-1作为二线治疗药物疗效尚可,贝伐珠单抗的治疗效果亟需进一步试验证实。

Objective： To evaluate the efficacy of chemotherapy for advanced biliary tract carcinoma and the factors that influence survival. Methods： A total of 91 cases of advanced biliary tract carcinoma from January 2010 to April 2015 were enrolled in our study. The patients＇ characteristics, chemotherapy regimens, and effects were analyzed. Results： We enrolled 56 males and 35 females with a median age of 57 years. A total of 90 patients were assessable for their responses to first-line chemotherapy. A total of 69 patients re- ceived the GP regimen, whereas 21 patients received some other regimens. The disease control rate （DCR）, median progression free survival （mPFS）, and median overall survival （mOS） were 68.2% versus 52.4%, 5.20 months versus 2.50 months （P=0.025）, and 13.00 months versus 7.20 months, respectively. Only 31 patients received S-1 based regimens, and 12 patients received some other regi- mens as second-line chemotherapy. The DCR, median PFS, and median 05 showed no statistical differences. Only four patients received S-2 based regimen plus bevacizumab as second-line chemotherapy （median PFS 5.3 months; median OS 7 months）. Hematologi- cal toxicity was the most common side effect in the first-line GP regimen. The side effects of the S-1 based chemotherapy regimen was relatively less. Conclusion： The GP regimen is an effective first-line chemotherapy for advanced biliary tract carcinoma, whereas S-1 ap- pears as an effective second-line chemotherapy drug. Bevacizumab-based regimens may be effective and require further validation.