Phase Ⅰ trial of combination chemotherapy with gemcitabine, cisplatin, and S-1 in patients with advanced biliary tract cancer

AIM: To evaluate the dose-limiting toxicities(DLTs)and determine the maximum-tolerated dose(MTD) and recommended dose(RD) of combination chemotherapy with gemcitabine, cisplatin and S-1 which is an oral fluoropyrimidine pro-drug in patients with advanced biliary tract cancer.METHODS: Patients with histologically or cytologically confirmed unresectable or recurrent biliary tract cancer were enrolled. The planned dose levels of gemcitabine(mg/m2), cisplatin(mg/m2), and S-1(mg/m2 per day) were as follows: level-1, 800/20/60;level 0, 800/25/60; level 1, 1000/25/60; and level 2,1000/25/80. In each cycle, gemcitabine and cisplatin were administered intravenously on days 1 and 15,and S-1 was administered orally twice daily on days 1to 7 and days 15 to 21, every 4 wk.RESULTS: Twelve patients were enrolled, and level0 was chosen as the starting dose. None of the first three patients had DLTs at level 0, and the dose was escalated to level 1. One of six patients had DLTs(grade 4 febrile neutropenia, leucopenia, and neutropenia; grade 3 thrombocytopenia) at level 1.We then proceeded to level 2. None of three patients had DLTs during the first cycle. Although the MTD was not determined, level 2 was designated at the RD for a subsequent phase Ⅱ study.CONCLUSION: The RD was defined as gemcitabine1000 mg/m2(days 1, 15), cisplatin 25 mg/m2(days1, 15), and S-1 80 mg/m2 per day(days 1-7, 15-21),every 4 weeks. A phase Ⅱ study is planned to evaluate the effectiveness of combination chemotherapy withgemcitabine, cisplatin, and S-1 in advanced biliary tract cancer.

Combining of chemotherapy with targeted therapy for advanced biliary tract cancer:A systematic review and meta-analysis

BACKGROUND Targeted therapy(TT)has resulted in controversial efficacy as first-line treatment for biliary tract cancer(BTC).More efficacy comparisons are required to clarify the overall effects of chemotherapy(CT)combined with TT and CT alone on advanced BTC.AIM To conduct a meta-analysis of the available evidence on the efficacy of CT combined with TT for advanced BTC.METHODS The PubMed,EMBASE,ClinicalTrials,Scopus and Cochrane Library databases were systematically searched for relevant studies published from inception to August 2022.Only randomized clinical trials(RCTs)including comparisons between the combination of gemcitabine-based CT with TT and CT alone as firstline treatment for advanced BTC were eligible(PROSPERO-CRD42022313001).The odds ratios(ORs)for the objective response rate(ORR)and hazard ratios(HRs)for both progression-free survival(PFS)and overall survival(OS)were calculated and analyzed.Subgroup analyses based on different targeted agents,CT regimens and tumor locations were prespecified.RESULTS Nine RCTs with a total of 1361 individuals were included and analyzed.The overall analysis showed a significant improvement in ORR in patients treated with CT+TT compared to those treated with CT alone(OR=1.43,95%CI:1.11-1.86,P=0.007)but no difference in PFS or OS.Similar trends were observed in the subgroup treated with agents targeting epidermal growth factor receptor(OR=1.67,95%CI:1.17-2.37,P=0.004)but not in the subgroups treated with agents targeting vascular endothelial growth factor receptor or mesenchymal-epithelial transition factor.Notably,patients who received a CT regimen of gemcitabine+oxaliplatin in the CT+TT arm had both a higher ORR(OR=1.75,95%CI:1.20-2.56,P=0.004)and longer PFS(HR=0.83,95%CI:0.70-0.99,P=0.03)than those in the CT-only arm.Moreover,patients with cholangiocarcinoma treated with CT+TT had significantly increased ORR and PFS(ORR,OR=2.06,95%CI:1.27-3.35,PFS,HR=0.79,95%CI:0.66-0.94).CONCLUSION CT+TT is a potential first-line treatment for advanced BTC that leads to improved tumor control and survival outcomes,and highlighting the importance of CT regimens and tumor types in the application of TT.

Effect Observation of Clinical Treatment with Oxaliplatin and Tiggio for Biliary Tract Tumors on Advanced Stage

Objective:To investigate the effect of oxaliplatin combined with tiggio in the treatment of advanced biliary tract tumors.Methods:The research period was from November 2019 to November 2020.80 patients with advanced biliary tumor disease were enrolled.They were divided into groups according to the order of admission,with 40 cases in each group.The control group received oxaliplatin combined with gemcitabine,and the experimental group received oxaliplatin combined with tiggio.Incidence of adverse reactions,time to disease progression,survival time and clinical efficacy were checked and assessed.Results:Compared with the incidence of adverse reaction of the experimental group,which was 5.00%(2/40),the incidence of adverse reaction of the control group was 25.00%(10/40).The chi-square value=6.2745,p-value=0.0122.The time to progression and survival time of patients in the experimental group were shorter than those of the control group,with significant differences between the groups(p<0.05);the clinical efficacy of the experimental group and the control group were 97.50%(39/40)and 77.50%(31/40)respectively,the comparative chi-square value=7.3143,p-value=0.0068.Conclusion:The combined treatment of oxaliplatin and Tiggio in the treatment of advanced biliary tract tumors has higher safety and reduces the incidence of adverse reactions.

Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction

BACKGROUND For cases of middle and low biliary obstruction with left and right hepatic duct dilatation,the type of approach and whether different approaches affect the difficulty of puncture operation and intraoperative and postoperative complications have not been discussed in detail.AIM To compare the efficacy of different percutaneous transhepatic biliary stent placements and catheter drainage in treating middle and low biliary obstruction.METHODS A retrospective analysis was performed on the medical records of 424 patients with middle and low biliary obstruction who underwent percutaneous liver puncture biliary stent placement and catheter drainage at the Department of Interventional Radiology,Shaanxi Provincial People’s Hospital between March 2016 and March 2022.Based on the puncture path,patients were categorized into two groups:Subxiphoid left hepatic lobe approach group(Group A,224 cases)and right intercostal,right hepatic lobe approach group(Group B,200 cases).Liver function improvement,postoperative biliary bleeding incidence,postoperative pain duration,and abdominal effusion leakage around the drainage tube were compared between the two groups at 3 d and 1 wk after the surgery.Patient survival time was recorded during follow-up.RESULTS All 424 surgeries were successful without adverse events.Group A comprised 224 cases,and Group B had 200 cases.There was no statistically significant difference in basic data between Group A and Group B(P>0.05).No significant difference in postoperative biliary bleeding incidence was observed between the groups(P>0.05).The decreased rates for total bilirubin(Group A:69.23±4.50,Group B:63.79±5.65),direct bilirubin(Group A:79.30±11.19,Group B:63.62±5.64),and alkaline phosphatase(Group A:60.51±12.23,Group B:42.68±23.56)in the 1st wk after surgery were significantly faster in Group A than in Group B.The decreased rate of gamma-glutamyl transpeptidase was also significantly faster in Group A at both 3 d(Group A:40.56±10.32,Group B:32.22±5.12)and 1 wk(Group A:73.19±7.05,Group B:58.81±18.98)after surgery(P<0.05).Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B(P<0.05).The patient survival rate was higher in Group A compared to Group B(P<0.05).CONCLUSION In treating jaundice patients with middle and low biliary obstruction,a percutaneous left liver puncture demonstrated better clinical efficacy than a percutaneous right liver puncture.

Impact of biliary stent-related events in patients diagnosed with advanced pancreatobiliary tumours receiving palliative chemotherapy

AIM: To determine the impact(morbidity/mortality) of biliary stent-related events(SRE)(cholangitis or stent obstruction) in chemotherapy-treated pancreaticobiliary patients.METHODS: All consecutive patients with advanced pancreatobiliary cancer and a biliary stent in-situ prior to starting palliative chemotherapy were identified retrospectively from local electronic case-note records(Jan 13 to Jan 15). The primary end-point was SRE rate and the time-to-SRE(defined as time from first stenting before chemotherapy to date of SRE). Progressionfree survival and overall survival were measured from the time of starting chemotherapy. Kaplan-Meier, Cox and Fine-Gray regression(univariate and multivariable) analyses were employed, as appropriate. For the analysis of time-to-SRE, death was considered as a competing event.RESULTS: Ninety-six out of 693 screened patients were eligible; 89% had a metal stent(the remainder were plastic). The median time of follow-up was 9.6 mo(range 2.2 to 26.4). Forty-one patients(43%)developed a SRE during follow-up [cholangitis(39%), stent obstruction(29%), both(32%)]. There were no significant differences in baseline characteristics between the SRE group and no-SRE groups. Recorded SRE-consequences were: none(37%), chemotherapy delay(24%), discontinuation(17%) and death(22%). The median time-to-SRE was 4.4 mo(95%CI: 3.6-5.5). Patients with severe comorbidities(P < 0.001) and patients with ≥ 2 baseline stents/biliary procedures [HR = 2.3(95%CI: 1.2-4.44), P = 0.010] had a shorter time-to-SRE on multivariable analysis. Stage was an independent prognostic factor for overall survival(P = 0.029) in the multivariable analysis adjusted for primary tumour site, performance status and development of SRE(SRE group vs no-SRE group).CONCLUSION: SREs are common and impact on patient's morbidity. Our results highlight the need for prospective studies exploring the role of prophylactic strategies to prevent/delay SREs.

Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction. METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malig- nant biliary tract diseases. Quantitative real-time re- verse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling.RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expres- sion, patient's age and serum bilirubin were each inde- pendently associated with overall survival. CONCLUSION: CK19 mRNA expression levels in pe- ripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.

Biliary tract intraductal papillary mucinous neoplasm: Report of 19 cases

AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343 biliary tract tumors resected in our single institution.Demographic characteristics, clinical data, pathology, surgical strategies, and long-term follow-up were analyzed.RESULTS: The mean age of the 19 BT-IPMN cases was 53.8 years(range: 25-74 years).The most common symptom was abdominal pain(15/19; 78.9%), followed by jaundice(7/19; 36.8%).Cholangitis was associated with most(16/19; 84.2%) of the BT-IPMN cases.Macroscopically visible mucin was detected in all 19 patients, based on original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilation(19/19; 100%) and intraluminal masses(10/19; 52.6%).Thirteen(68.4%) cases involved the intrahepatic bile duct and hilum.We performed left hepatectomy in 11/19(57.9%), right hepatectomy in 2/19(10.5%), bile duct resection in 4/19(21.1%), and pancreatoduodenectomy in 1/19(5.3%) patients.One(5.3%) patient was biopsied and received a choledochojejunostomy because of multiple tumors involving the right extrahepatic and left intrahepatic bile ducts.Histology showed malignancy in 10/19(52.6%) patients.The overall median survival was 68 mo.The benign cases showed a non-significant trend towards improved survival compared to malignant cases(68 mo vs 48 mo, P = 0.347).The patient without tumor resection died of liver failure 22 mo after palliative surgery.CONCLUSION: BT-IPMN is a rare biliary entity.Complete resection of the tumor is associated with good survival, even in patients with malignant disease.

Immunotherapy in biliary tract cancers:Current evidence and future perspectives

Bile duct tumors are comprised of tumors that originate from both intrahepatic and extrahepatic bile ducts and gallbladder tumors.These are aggressive tumors and chemotherapy is still the main treatment for advanced-stage disease and most of these cases have a poor overall survival.Strategies are aimed at treatments with better outcomes and less toxicity which makes immunotherapy an area of significant importance.Recent Food and Drug Administration approvals of immune checkpoint inhibitors(ICI)for agnostic tumors based on biomarkers such as microsatellite instability-high and tumor mutation burden-high are important steps in the treatment of patients with advanced bile duct tumors.Despite limited responses with isolated checkpoint inhibitors in later lines of systemic treatment in advanced disease,drug combination strategies have been demonstrating encouraging results to enhance ICI efficacy.

Disease control with sunitinib in advanced intrahepatic cholangiocarcinoma resistant to gemcitabine-oxaliplatin chemotherapy

Advanced cholangiocarcinoma is associated with poor prognostic survival and has limited therapeutic options available at present. The importance of angiogenesis and expression of pro-angiogenic factors in intrahepatic forms of cholangiocarcinoma suggest that therapies targeting angiogenesis might be useful for the treatment of this disease. Here we report three cases of patients with advanced intrahepatic cholangiocarcinoma progressive after standard chemotherapy and treated with sunitinib 50 mg/d in 6-wk cycles of 4 wk on treatment followed by 2 wk off treatment(Schedule 4/2). In all three patients, sunitinib treatment was associated with a sustained disease control superior to 4 mo, patients achieving either a partial response or stable disease. A reduction in tumor size and density was observed in all cases, suggesting tumor necrosis as a result of sunitinib treatment in these patients. In addition, sunitinib was generally well tolerated and the occurrence of side effects was managed with standard medical interventions, as required. Our results suggest that sunitinib therapy maybe associated with favorable outcomes and tolerability in patients with advanced cholangiocarcinoma. Those observations contributed to launch a prospective phase Ⅱ multicenter trial investigating sunitinib in advanced intrahepatic cholangiocarcinoma(SUN-CK study; NCT01718327).

Biliary tract cancer stem cells-translational options and challenges

Management of biliary tract cancer remains challenging. Tumors show high recurrence rates and therapeutic resistance, leading to dismal prognosis and short survival. The cancer stem cell model states that a tumor is a heterogeneous conglomerate of cells, in which a certain subpopulation of cells-the cancer stem cells-possesses stem cell properties. Cancer stem cells have high clinical relevance due to their potential contributions to development, progression and aggressiveness as well as recurrence and metastasis of malignant tumors. Consequently, reliable identification of as well as pharmacological intervention with cancer stem cells is an intensively investigated and promising research field. The involvement of cancer stem cells in biliary tract cancer is likely as a number of studies demonstrated their existence and the obvious clinical relevance of several established cancer stem cell markers in biliary tract cancer models and tissues. In the present article, we review and discuss the currently available literature addressing the role of putative cancer stem cells in biliary tract cancer as well as the connection between known contributors of biliary tract tumorigenesis such as oncogenic signaling pathways, micro-RNAs and the tumor microenvironment with cancer stem cells.

Research Progress of Circulating Tumor Cells in the Evaluation of Early Cholangiocarcinoma

Epidemiological data show that the incidence rate of cholangiocarcinoma(CCA)has been increasing over the past 20 years.Due to its concealment of clinical manifestations,most patients are diagnosed with CCA at a late stage.On this premise,this review not only discusses the research progress related to CCA diagnosis,but also focuses on the concept of circulating tumor cell(CTC),its evaluation value,application,and prospects for the early diagnosis of extrahepatic cholangiocarcinoma.

腹腔镜胰腺肿瘤剜除术后胆道并发症的危险因素分析

目的:探讨腹腔镜胰腺肿瘤剜除术后发生胆道并发症的危险因素。方法:回顾分析2017年3月至2023年6月101例接受腹腔镜胰腺肿瘤剜除术患者的临床及随访资料。其中男29例,女72例,15~77岁,平均(48.6±13.2)岁。肿瘤位于胰头部49例(48.5%)、胰颈体尾部52例(51.5%)。根据术后是否发生胆道并发症分为胆道并发症组(n=24)与无胆道并发症组(n=77)。单因素分析中定量数据采用t检验或Mann-Whitney U检验进行比较,分类数据采用χ^(2)检验进行比较,采用多因素Logistic回归分析术后发生胆道并发症的独立危险因素。结果:患者均在腹腔镜下顺利完成肿瘤剜除术,无术中输血及中转开腹,手术时间63~359 min,平均(168.0±58.7)min。术后长期随访,24例(23.8%)发生胆道并发症,其中胆囊结石21例、胆囊炎2例、胆囊结石合并胆总管结石1例;77例(76.2%)未发生胆道并发症。单因素分析结果显示,体重指数大(P=0.008)、术后第1天γ-谷氨酰转移酶高(P=0.04)、肿瘤位于胰头部(P=0.012)、肿瘤最大径长(P=0.028)、生长抑素使用总量多(P<0.001)是术后发生胆道并发症的危险因素。将上述危险因素纳入多因素Logistic回归分析,结果显示体重指数大(OR=1.262,95%CI=1.025~1.554,P=0.028)、肿瘤位于胰头部(OR=4.042,95%CI=1.242~13.155,P=0.020)、生长抑素使用总量多(OR=1.381,95%CI=1.059~1.800,P=0.017)是腹腔镜胰腺肿瘤剜除术后发生胆道并发症的独立危险因素。结论:腹腔镜胰腺肿瘤剜除术是治疗胰腺良性、低度恶性肿瘤的有效术式,对于具有上述危险因素的患者,应在出院后加强监测胆道并发症的发生情况。

肿瘤浸润淋巴细胞治疗胆道癌研究进展

肿瘤浸润淋巴细胞(TIL)是存在于肿瘤实质和间质内的以T淋巴细胞为主的一类异质性淋巴细胞群体。将其从肿瘤组织消化和分离出来,经体外培养活化和扩增后,回输到患者体内可以起到杀伤肿瘤细胞的作用。TIL具有T淋巴细胞抗原受体的高度多样性、优异的浸润肿瘤部位能力以及低毒性等优势,被认为有希望用于治疗恶性实体肿瘤。目前,TIL疗法已在多种实体瘤中作为二线治疗进行临床试验并取得初步疗效。虽然目前尚无TIL应用于胆道癌单一病种的临床队列报道,近期的多癌种临床报道提供了少数接受TIL治疗的胆道癌患者的疗效信息,初步证实了安全性和有效性。但由于胆道癌一般被认为是大多数效应T淋巴细胞被隔离在肿瘤边缘的免疫排斥性肿瘤,TIL在胆道癌中的抗肿瘤作用仍难以预测。尝试与不同抗肿瘤方法的联合治疗以及开发新技术修饰细胞以增强TIL抗肿瘤能力是未来可能突破的发展方向。

晚期消化道恶性肿瘤患者安宁疗护需求及与家属认知程度 社会支持情况的相关性

目的探讨晚期消化道恶性肿瘤患者安宁疗护需求及与家属认知程度、社会支持情况的相关性。方法将125例消化道恶性肿瘤患者作为研究对象,采用自制安宁疗护需求量表、家属认知程度量表及社会支持情况量表进行调查,采用单因素分析及Logistic回归分析探讨消化道恶性肿瘤患者安宁疗护需求影响因素,利用乘法及加法模型评定家属认知程度、社会支持情况交互作用对安宁疗护需求的影响。结果入组患者安宁疗护需求评分为(60.61±4.79)分;年龄、人均月收入、文化程度、家属认知程度及社会支持均为消化道恶性肿瘤患者安宁疗护需求的影响因素(P<0.01);消化道恶性肿瘤患者家属认知程度、社会支持情况与安宁疗护需求呈显著正相关(P<0.01);家属认知程度单独所致的比值比为2.125,社会支持单独所致的比值比为1.607,两者同时存在时,交互作用比值比为6.429,相关系数为3.918,提示家属认知程度、社会支持情况在消化道恶性肿瘤患者安宁疗护需求呈正向交互作用,6.429>2.125×1.607提示家属认知程度与社会支持情况为超相乘模型。结论消化道恶性肿瘤患者安宁疗护需求处于中等偏上水平,与家属认知程度、社会支持情况呈显著正相关,临床应予以充分重视。

中国胆道肿瘤多学科综合治疗专家共识

胆道肿瘤发病率逐年上升,整体预后差。临床上通常以治疗目标为导向和临床分期制订治疗策略。对于早期胆道肿瘤,以外科手术为主,力争R0切除,结合术中或术后放疗、肝内消融、术后化疗,采用个体化综合治疗方案。晚期胆道肿瘤患者以全身系统治疗为主,包括化疗、靶向治疗和免疫治疗,单一手段疗效欠佳,通常需要多种治疗的组合。近年来以多学科综合治疗(multi-disciplinary treatment,MDT)为主的诊疗模式已经成为胆道肿瘤患者延长生存的重要策略。随着精准靶向治疗以及免疫联合治疗的数据不断被刷新,胆道肿瘤的治疗格局持续改变,迫切需要更加规范、高效的MDT参与到诊疗过程中以提高诊疗水平,为此中国研究型医院学会精准医学与肿瘤MDT专业委员会组织专家制定《中国胆道肿瘤多学科综合治疗专家共识》。

FoxM1在肝胆胰恶性肿瘤中的作用及机制研究进展

叉头盒蛋白M1(FoxM1)作为Forkhead基因超家族的一员,是调节细胞增殖和凋亡的重要转录因子。近年研究发现,FoxM1在人类肝胆胰恶性肿瘤中异常表达,并且与其侵袭转移及预后密切相关。随着其作用机制的不断明确,FoxM1可望作为肝胆胰恶性肿瘤新的预后生物标志物和治疗靶点。本文就近年来FoxM1在肝胆胰常见恶性肿瘤的作用及相关机制研究进展进行综述。

安宁护理对消化道肿瘤晚期患者心理状态及生存质量的影响分析

目的探讨对消化道肿瘤晚期患者进行安宁护理后其心理状态及生活质量等多方面的变化。方法随机选取2019年1月—2023年9月江苏省仪征市人民医院收治的90例消化道肿瘤晚期患者为研究对象,按照随机抽签法分为两组,对照组采用常规护理,观察组采用安宁护理,对比分析两组患者在心理状态及生存质量上的差异。结果护理后,观察组死亡恐惧量表评分(7.34±0.62)分、焦虑自评量表评分(43.43±2.52)分、抑郁自评量表评分(46.23±1.13)分均显著低于对照组(10.22±0.68)分、(48.23±1.24)分、(51.53±1.39)分,差异有统计学意义(t=20.995、11.465、19.847,P均<0.05);观察组生存质量量表各维度评分均显著高于对照组,差异有统计学意义(P<0.05)。结论消化道肿瘤晚期患者在接受安宁护理后其恐惧心理、焦虑情绪、抑郁心境持续改善,整体生活质量显著提升。

Imaging features and appropriate treatment strategy of a rare biliary tract neoplasm

Mucin-producing bile duct tumors （MPBTs） are characterized by intraductal papillary tumorsproducing large amounts of mucin. The tumor comprises macroscopically prominent intraductal papillary neoplastic epithelia and produces a large amount of viscid mucin, resulting in dilatation of the bile ducts.1 These tumors of the peripheral bile duct, which include benign and malignant lesions, have also been referred to as intraductal growth- type peripheral cholangiocarcinomas,2 mucin-producing cholangiocellular carcinomas,3 intraductal papillary neoplasms （IPNs） of the biliary tract,4 IPNs of the liver,5 or IPNs of the bile duct.6 MPBTs have been the subject of recent attention due to its peculiar histopathology, biological and clinical behavior, varied radiological manifestations, and good prognosis of the patients] Due to the rarity of this disease entity and the non-specific clinical presentation, MPBTs are not well characterized. The purpose of this study was to define the precise diagnosis and correct management of MPBTs with the help of nine clinical cases observed in the last 10 years. The preoperative differential diagnosis, surgical procedure, and postoperative course of these nine cases were retrospectively reviewed.

胆汁肿瘤标志物检测对胆管良恶性狭窄的鉴别诊断价值

目的探讨胆道胆汁肿瘤标志物CA19-9、CA50、和CEA对鉴别胆道良恶性狭窄的价值。方法对37例胆道恶性狭窄及35例胆道良性狭窄和25例非胰胆管疾病者在ERCP或PTC时提取胆汁,用放射免疫法(RIA)及免疫放射法(IRMA)测定胆汁和血清的CA19-9、CA50和CEA含量。结果胆汁肿瘤标志物CA19-9、CA50及CEA测定的敏感性特异性与血清测定比较均有显著差异(P<0.05)。胆汁CA19-9的假阳性率(14.28%)与胆汁CA50(28.57%)、胆汁CEA(25.71%)相比较有极显著差异(P<0.01)。结论胆汁CA19-9、CA50及CEA检测是鉴别胆道良恶性狭窄有效的肿瘤标志物,且优于血清CA19-9、CA50及CEA检测。胆汁CA19-9测定对胆管癌诊断的价值优于胆汁CA50及CEA。

晚期胆系恶性肿瘤化疗方案的回顾性研究

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。