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。 

Retrospective study on chemotherapy for advanced biliary tract carcinoma

Objective:To evaluate the efficacy of chemotherapy for advanced biliary tract carcinoma and the factors that influence sur-vival. Methods:A total of 91 cases of advanced biliary tract carcinoma from January 2010 to April 2015 were enrolled in our study. The patients' characteristics, chemotherapy regimens, and effects were analyzed. Results:We enrolled 56 males and 35 females with a me-dian age of 57 years. A total of 90 patients were assessable for their responses to first-line chemotherapy. A total of 69 patients re-ceived the GP regimen, whereas 21 patients received some other regimens. The disease control rate (DCR), median progression free survival (mPFS), and median overall survival (mOS) were 68.1%versus 52.4%, 5.10 months versus 2.50 months (P=0.025), and 13.00 months versus 7.20 months, respectively. Only 31 patients received S-1 based regimens, and 12 patients received some other regi-mens as second-line chemotherapy. The DCR, median PFS, and median OS showed no statistical differences. Only four patients re-ceived S-1 based regimen plus bevacizumab as second-line chemotherapy (median PFS 5.3 months;median OS 7 months). Hematologi-call toxicity was the most common side effect in the first-line GP regimen. The side effects of the S-1 based chemotherapy regimen was relatively less. Conclusion:The GP regimen is an effective first-line chemotherapy for advanced biliary tract carcinoma, whereas S-1 ap-pears as an effective second-line chemotherapy drug. Bevacizumab-based regimens may be effective and require further validation.