新辅助治疗在局部晚期肝门部胆管癌术前降期治疗中的应用价值
Application value of neoadjuvant therapy in preoperative downstaging of locally advanced hilar cholangiocarcinoma
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摘要:
肝门部胆管癌是最常见的胆管恶性肿瘤，根治性手术是唯一可获得长期生存的治疗手段，获得R0切除的肝门部胆管癌患者5年生存率可达20%～40%。然而，约65%患者在发现肿瘤时由于肿瘤侵犯血管或出现远处转移而无法行根治性肝切除术。新辅助治疗包括放化疗联合方案，可能使初期评估无法切除的局部晚期肝门部胆管癌在降期后获得根治性切除机会。新辅助光动力治疗也可使部分高选的局部晚期肝门部胆管癌患者施行根治性切除术，降低局部复发，而且不良反应轻微。对于肿瘤长径<2 cm，不适合手术切除的肝门部胆管癌患者，经过新辅助治疗后施行肝移植有望获得比根治性切除更长的生存时间。笔者探讨新辅助治疗在局部晚期肝门部胆管癌术前降期治疗中的应用价值。
Abstract:Hilar cholangiocarcinoma is the common cancer of bile ducts. Radical resection with negative margins is the only potential cure treatment, and the 5-year survival rate varies from 20%-40% in most series. However, about 65% of patients are unresectable at the time of diagnosis because of vascular involvement and metastatic disease. Neoadjuvant therapy including chemoradiotherapy allowed patients with initially unresectable locally advanced cholangiocarcinomas to be reclassified as surgical candidates in a substantial proportion. Neoadjuvant photodynamic therapy might be one of the treatment options for highly selected patients with advanced cholangiocarcinoma, which reduces the rate of local recurrence and shows minor adverse reactions after potentially curative resection. Followed by downstaging after neoadjuvant chemoradiotherapy, liver transplantation may contribute to superior survival outcomes in the same patients with hilar tumor diameter <2 cm compared to curative-intent resection. The authors investigate the application value of neoadjuvant therapy in preoperative downstaging of locally advanced hilar cholangiocarcinoma.
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