PDF(Pubmed)
Abstract：
Periampullary carcinoma is a malignant gastrointestinal tumor originating from the head of the pancreas, distal bile duct, duodenum, or the ampulla of Vater. Currently, surgery remains the primary treatment option, yet the postoperative recurrence rate remains high. Chemotherapy is the main approach for controlling postoperative recurrence. Histologically, periampullary carcinoma is categorized into two types: intestinal (IN) and pancreaticobiliary (PB) subtype. Each subtype requires different therapeutic approaches, with the PB type primarily treated with gemcitabine and the IN type with 5-FU. Despite these options, patient outcomes are still unsatisfactory. In recent years, the feasibility of immunotherapy in tumor treatment has been increasingly evidenced, although research on its efficacy in periampullary carcinoma treatment is still limited. In this report, we present a case of a periampullary carcinoma patient who experienced recurrence and metastasis after undergoing radical pancreatoduodenectomy and receiving gemcitabine-based chemotherapy post-surgery. Through next-generation sequencing (NGS), we identified high expression levels of programmed cell death-ligand 1 (PD-L1) with a combined positive score (CPS) of 35, high tumor mutation burden (TMB-H), and high microsatellite instability (MSI-H) in this patient. Therefore, we implemented a combination therapy using Tislelizumab and chemotherapy. According to the latest follow-up, the tumors are effectively controlled. Our utilization of immunotherapy combined with chemotherapy holds significant implication for the treatment of periampullary carcinoma.
摘要：
壶腹周围癌是一种起源于胰头的恶性胃肠道肿瘤，远端胆管,十二指肠,或者Vater的壶腹.目前,手术仍然是主要的治疗选择，然而术后复发率仍然很高。化疗是控制术后复发的主要方法。组织学上,壶腹周围癌分为两种类型：肠（IN）和胰胆管（PB）亚型。每种亚型都需要不同的治疗方法，PB型主要用吉西他滨治疗，IN型主要用5-FU治疗。尽管有这些选择,患者预后仍不令人满意.近年来,免疫治疗在肿瘤治疗中的可行性已日益得到证实,尽管其在壶腹周围癌治疗中的疗效研究仍然有限。在这份报告中,我们介绍了一例壶腹周围癌患者,该患者在接受根治性胰十二指肠切除术并在术后接受以吉西他滨为基础的化疗后出现复发和转移.通过下一代测序（NGS），我们鉴定了高表达水平的程序性细胞死亡配体1（PD-L1），其联合阳性评分（CPS）为35，高肿瘤突变负荷（TMB-H），该患者的微卫星不稳定性（MSI-H）很高。因此,我们实施了使用Tislelizumab和化疗的联合治疗.根据最新的随访，肿瘤得到有效控制。我们使用免疫疗法结合化疗对壶腹周围癌的治疗具有重要意义。
