Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma
Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma
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DOI：
10.1002/bjs.10641
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发表时间：
2018-06-01
影响因子：
9.6
通讯作者：
Cunha, A. Sa
中科院分区：
文献类型：
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作者：
Le Roy, B.;Gelli, M.;Cunha, A. Sa
背景资料：肝内胆管细胞癌（ICC）在诊断时的局部区域性扩散导致可切除率低和预后差。本回顾性研究的目的是评估新辅助化疗对局部晚期ICC.Methods的疗效：2000年至2013年期间所有连续ICC患者前瞻性纳入单中心数据库并进行回顾性分析。局部晚期ICC患者最初被认为是不可切除的，接受原发性化疗，然后在那些继发性可切除的患者中进行手术。结果进行手术治疗的局部晚期ICC的患者进行了比较与那些最初可切除的ICC单独手术治疗的患者。在74例局部晚期ICC患者中，39例（53%）在中位6个化疗周期后接受了二次切除术。与单纯手术组相比，该组患者更年轻（P = 0.030），病情更严重，淋巴结肿大（P = 0.010）和血管浸润（P = 0.010）更常见。两组的术后发病率和死亡率无差异。化疗后手术治疗的中位生存期为24.1个月，单纯手术治疗的中位生存期为25.7个月（P = 0.391）。新辅助化疗作为局部晚期ICC的一线治疗可能是一种有效的降期选择，有助于最初不可切除疾病患者的二次切除。
Background: Locoregional extension of intrahepatic cholangiocarcinoma (ICC) at the time of diagnosis results in a low resectability rate and poor prognosis. The aim of this retrospective study was to assess the efficacy of neoadjuvant chemotherapy for locally advanced ICC.Methods: All consecutive patients with ICC between 2000 and 2013 were included prospectively in a single-centre database and analysed retrospectively. Patients with locally advanced ICC considered as initially unresectable received primary chemotherapy, followed by surgery in those with secondary resectability. Results of patients who underwent surgery for locally advanced ICC were compared with those of patients with initially resectable ICC treated by surgery alone.Results: A total of 186 patients were included in the study. Of 74 patients with locally advanced ICC, 39 (53 per cent) underwent secondary resection after a median of six chemotherapy cycles. Patients in this group were younger (P = 0.030) and had more advanced disease than those who had surgery alone, and presented more frequently with lymphadenopathy (P = 0.010) and vascular invasion (P = 0.010). Postoperative morbidity and mortality were no different between the groups. The median survival of patients who had surgery after chemotherapy was 24.1 months, and that of patients who had surgery alone was 25.7 months (P = 0.391).Conclusion: Patients with locally advanced ICC treated by surgery following neoadjuvant chemotherapy had similar short-and long-term results to patients with initially resectable ICC who had surgery alone. Neoadjuvant chemotherapy as a first-line treatment for locally advanced ICC may be an effective downstaging option, facilitating secondary resectability in patients with initially unresectable disease.