Gemcitabine Plus Cisplatin Versus Non-Gemcitabine and Cisplatin Regimens as Neoadjuvant Treatment for Cholangiocarcinoma Patients Prior to Liver Transplantation: An Institution Experience.
Gemcitabine Plus Cisplatin Versus Non-Gemcitabine and Cisplatin Regimens as Neoadjuvant Treatment for Cholangiocarcinoma Patients Prior to Liver Transplantation: An Institution Experience.
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DOI：
10.3389/fonc.2022.908687
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发表时间：
2022
影响因子：
4.7
通讯作者：
Ghobrial, Rafik M.
中科院分区：
文献类型：
--
作者：
Abdelrahim, Maen;Esmail, Abdullah;Xu, Jiaqiong;Umoru, Godsfavour;Al-Rawi, Hadeel;Saharia, Ashish;Abudayyeh, Ala;Victor, David;McMillan, Robert;Kodali, Sudha;Ghobrial, Rafik M.
关键词：
胆管癌的管理正在不断更新，鉴于现有的证据，以建立实践指南和共识声明。然而，现有的治疗指南，以优化结果的胆管癌患者谁需要肝移植仍有争议。本研究通过研究一种新的有前途的新辅助治疗方法，为胆管癌患者提供肝移植选择，从而为胆管癌治疗领域做出贡献。在此，我们评估并比较了吉西他滨+顺铂化疗联合方案与非吉西他滨+顺铂方案作为肝移植前胆管癌患者新辅助治疗的潜在疗效。在这项回顾性研究中，没有肝外疾病或血管受累证据的局部晚期、不可切除、肝门或肝内胆管癌患者接受新辅助吉西他滨+顺铂联合治疗，无放疗或其他标准新辅助治疗方案。所有患者在根据开放标签和中心批准的临床管理方案与同一机构的移植中心合作在单个癌症中心进行肝移植之前接受化疗。如果患者有至少6个月的扫描显示反应或疾病稳定的确认，则将其列为肝移植。主要终点是肝移植后的总生存期和无复发生存期。本报告于2022年3月18日被审查。在总共筛选的707名肝移植受者中，37名患者被确诊为胆管癌，只有18名患者（11名男性和7名女性）符合入选标准，中位年龄为61.83岁[四分位距：58.27-68.74]。在入组的18例患者中，10例接受吉西他滨/顺铂，8例接受吉西他滨单药治疗或卡培他滨或FOLFIRI。吉西他滨/顺铂组移植后复发的月数为20.1（IRQ：20.1-20.1），非吉西他滨/顺铂组为9.5（8.9-12.47）个月（p值=0.18）。吉西他滨/顺铂组的中位随访月数为28.35（27.1-32.23）个月，而非吉西他滨/顺铂组为40.12（20.6-56.22）个月（p值=0.33）。在非吉西他滨/顺铂患者中，第1年和第2年的总生存率为75%（95% CI 31-93%）;第3 - 5年为63%（95% CI 23-86%）。在吉西他滨/顺铂患者中，第1年和第2年的总生存率均为100%（95% CI 100-100%）;第3 - 5年为75%（95% CI 13-96%）。3名非吉西他滨/顺铂患者分别在328天、340天和896天死亡。1例吉西他滨/顺铂患者在885天时死亡。我们的研究结果表明，与非吉西他滨/顺铂方案相比，吉西他滨+顺铂作为肝移植前胆管癌患者的新辅助治疗，无伴随放疗，可改善总生存结局。
Cholangiocarcinoma management is constantly being updated in view of existing evidence in order to establish practice guidelines and consensus statements. However, the available treatment guidelines to optimize outcomes for cholangiocarcinoma patients who require liver transplantation are still controversial. This study contributing to the cholangiocarcinoma care field by investigating a new promising neoadjuvant therapy that might be help to grant the liver transplant option to the patients with cholangiocarcinoma. Here, we evaluate and compare the potential efficacy of chemotherapy combination of Gemcitabine plus Cisplatin versus non- Gemcitabine and Cisplatin regimens as a neo-adjuvant treatment for cholangiocarcinoma patients prior to liver transplantation. In this retrospective study, patients with locally advanced, unresectable, hilar, or intrahepatic cholangiocarcinoma with no evidence of extrahepatic disease or vascular involvement were treated with either the combination of neo-adjuvant Gemcitabine plus Cisplatin with no radiation or other standard options of neo-adjuvant treatment. All patients included received chemotherapy prior to being listed for liver transplantation at a single cancer center in collaboration with the same institution’s transplant center according to an open-labeled, and centers-approved clinical management protocol. Patients were listed for liver transplantation if they had a minimum of six months of scans showing response or confirmation of disease stability. The primary endpoints were the overall survival and recurrence-free survival after liver transplantation. This report, which was censored on March 18, 2022. Out of a total of 707 liver transplant recipients were screened, 37 patients were confirmed with a diagnosis of cholangiocarcinoma and only 18 patients (11 males and 7 females) with a median age of 61.83 [interquartile range: 58.27-68.74] met inclusion criteria. Of the 18 patients enrolled, 10 received Gemcitabine/Cisplatin, while 8 patients received either Gemcitabine monotherapy or Capecitabine or FOLFIRI. Months for recurrence after transplantation was 20.1 (IRQ: 20.1-20.1) in the Gemcitabine/Cisplatin group and 9.5 (8.9-12.47) months in the non-Gemcitabine/Cisplatin group (p-value=0.18). Median months of follow-up in the Gemcitabine/Cisplatin group was 28.35 (27.1-32.23) months versus 40.12 (20.6-56.22) months in the non-Gemcitabine/Cisplatin group (p-value=0.33). In non-Gemcitabine/Cisplatin patients, overall survival was 75% (95% CI 31-93%) at both years 1 and 2; 63% (95% CI 23-86%) at years 3 to 5. In Gemcitabine/Cisplatin patients, overall survival was 100% (95% CI 100-100%) at both years 1 and 2; 75% (95% CI 13-96%) at years 3 to 5. Three non-Gemcitabine/Cisplatin patients died at 328 days, 340 days, and 896 days, respectively. One Gemcitabine/Cisplatin patient died at 885 days. Our findings suggest improved overall survival outcomes with Gemcitabine plus Cisplatin as neo-adjuvant treatment with no concomitant radiation compared to non-Gemcitabine/Cisplatin regimens in patients with cholangiocarcinoma prior to liver transplantation.
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DOI：
10.1016/j.jamcollsurg.2010.12.005
发表时间：
2011-04-01
影响因子：
5.2
作者：
Hong, Johnny C.;Petrowsky, Henrik;Busuttil, Ronald W.
通讯作者：
Busuttil, Ronald W.
影响因子：
3.2
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Schulick, Richard D.
DOI：
10.1016/j.ijrobp.2008.03.018
发表时间：
2008-12-01
影响因子：
7
作者：
Shinohara, Eric T.;Mitra, Nandita;Metz, James M.
通讯作者：
Metz, James M.
影响因子：
13.5
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Sapisochin, G.;Facciuto, M.;Bruix, J.
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影响因子：
9
作者：
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Nagorney, DM