Gallbladder cancer: Can newer insights improve the outcome?
Gallbladder cancer: Can newer insights improve the outcome?
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DOI：
10.1111/j.1440-1746.2011.07048.x
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发表时间：
2012-04-01
影响因子：
4.1
通讯作者：
Dutta, Usha
中科院分区：
文献类型：
--
作者：
Dutta, Usha
胆囊癌（GBC）是某些地理区域癌症相关死亡率的主要原因。大多数GBC患者在就诊时已是晚期，无法进行根治性切除，预后不良。然而，最近在了解其流行病学和发病机制方面取得的进展，加上新的诊断工具和治疗方案的发展，使人们对该病的管理更加乐观。主要的危险因素是胆结石、年龄增长、女性、异常胰胆管连接、某些种族群体和地理群体。放射影像学的进步和超声内镜的出现促进了肿瘤的早期发现和准确分期。在高危人群中高度怀疑是必要的，以挑选偶然和早期GBC，因为手术切除是治愈性的。在怀疑GBC的患者中，主张进行适合该阶段的开放手术切除。辅助联合化疗和分子靶向治疗正在成为晚期GBC患者的有效治疗选择。内镜下应用金属支架缓解胆道和胃出口梗阻改善了患者的生活质量。预防仍然是迄今为止较少探索的降低GBC相关死亡率的选择。在高危人群中预防性胆囊切除术是一种具有成本效益的选择。采取多学科、系统的全球办法，开展合作，了解流行病学，使管理战略标准化，用新的治疗剂进行多中心试验，并采取预防措施，将为今后战胜这一疾病铺平道路。
Gallbladder cancer (GBC) is the leading cause of cancer related mortality in certain geographic areas. Most of the patients with GBC have advanced disease at presentation, precluding curative resection resulting in a dismal prognosis. However, recent advances in the understanding of its epidemiology and pathogenesis coupled with development of newer diagnostic tools and therapeutic options, has resulted in enhanced optimism towards the management of the disease. The leading risk factors are gallstones, advancing age, female gender, anomalous pancreaticobiliary ductal junction, certain ethnic groups and geographic populations. Advances in radiological imaging and the advent of endoscopic ultrasound have facilitated early detection and accurate staging of the tumor. A high index of suspicion in high risk groups is necessary to pick up incidental and early GBC, as surgical resection is curative. In patients with suspected GBC, an open surgical resection that is appropriate for that stage is advocated. Adjuvant combination chemotherapy and molecular targeted therapy are emerging as effective therapeutic options in those with advanced GBC. Endoscopic palliation of biliary and gastric outlet obstruction with metallic stents has improved their quality of life. Prevention remains the hitherto less explored option to reduce GBC related mortality. Prophylactic cholecystectomy in high risk groups is a cost-effective option. A multi-disciplinary systematic global approach to initiate collaborative ventures to understand epidemiology, standardize management strategies, conduct multi-centric trials with newer therapeutic agents and initiate preventive measures, would pave way for the future conquest of the disease.