Investigation of neoadjuvant gemcitabine plus cisplatin-based triplet regimens on biliary tract cancer with possible lymph node metastasis

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-05-13 DOI:10.1016/j.ejso.2025.110149

Shogo Kobayashi, Hirofumi Akita, Daisaku Yamada, Kazuki Sasaki, Shinichiro Hasegawa, Yoshito Tomimaru, Takehiro Noda, Hidenori Takahashi, Yuichiro Doki, Hidetoshi Eguchi

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引用次数: 0

Abstract

Introduction

Biliary tract cancer (BTC) is rare. The treatment outcomes in patients with lymph node (LN) metastasis diagnosed by FDG-PET or a biopsy—who are considered to be ‘biologically borderline resectable’—are poor. However, perioperative treatment is still under development. Recently, gemcitabine plus cisplatin (GC)-based triplet regimens for unresectable BTC have been developed. We applied GC-based triplet therapy in BTC with LN metastasis.

Methods

We administered GC plus S-1 therapy (GCS) or nab-paclitaxel therapy (GCnP) to 30 patients with LN metastasis diagnosed by FDG-PET or a biopsy (GC-based triplet group). A dataset of BTC with FDG-positive LNs, previously used for an analysis of the diagnosis and treatment outcomes according to FDG uptake, was used as a control (upfront surgery group, n = 19).

Results

GCS and GCnP were used by 22 and 8 patients, respectively. The median treatment period was 79 days, the objective response rate was 47 %, the tumor control rate was 87 %, and 22 patients underwent R0 resection (73 %). The groups showed no significant differences with the exception of the FDG uptake by the main tumor. The three-year overall survival (OS) rates in the GC-based triplet and upfront surgery groups were 45.4 % and 15.8 %, respectively (P = 0.0052); there were no significant differences in progression-free or recurrence-free survival. A sub-analysis showed that normalized CA19-9 levels provided better survival than non-normalized CA19-9 levels.

Conclusion

Neoadjuvant GC-based triplet regimens could provide survival benefits in BTC with LN metastasis diagnosed by FGD-PET or a biopsy. CA19-9 normalization may be useful for indicating surgery.

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新辅助吉西他滨加顺铂三联治疗胆道癌伴淋巴结转移的研究

胆道癌（BTC）是罕见的。通过FDG-PET或活检诊断的淋巴结转移患者（被认为是“生物学上可切除的”）的治疗结果很差。然而，围手术期治疗仍在发展中。最近，吉西他滨+顺铂（GC）为基础的三联方案已经开发用于不可切除的BTC。我们采用以gc为基础的三联疗法治疗伴有淋巴结转移的BTC。方法对30例经FDG-PET或活检诊断为LN转移的患者（以GC为基础的三联组）进行GC + S-1治疗（GCS）或nab-紫杉醇治疗（GCnP）。使用FDG阳性LNs的BTC数据集作为对照（前期手术组，n = 19），该数据集先前用于根据FDG摄取分析诊断和治疗结果。结果22例患者使用gcs， 8例患者使用GCnP。治疗中位期79天，客观有效率47%，肿瘤控制率87%，22例患者行R0切除术（73%）。除了主要肿瘤对FDG的摄取外，各组间无显著差异。基于gc的三联组和前期手术组的3年总生存率分别为45.4%和15.8% (P = 0.0052)；无进展生存期和无复发生存期无显著差异。亚分析显示，规范化CA19-9水平比非规范化CA19-9水平提供更好的生存率。结论基于gc的新辅助三重方案可提高FGD-PET或活检诊断为淋巴结转移的BTC患者的生存率。CA19-9正常化可能对指示手术有用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.