背景:本文件是法国胆道癌(BTC)治疗组间指南的摘要(肝内,肺门周围和远端胆管癌,和胆囊癌)于2023年9月出版,可在法国胃肠病学会(SNFGE)的网站上获得(www.tncd.org)。
方法:这项合作工作是在参与BTC管理的法国医学和外科学会的主持下进行的。建议分为三类(A,B和C)根据直到2023年8月的科学证据水平。
结果:BTC的诊断和分期主要基于增强计算机断层扫描,磁共振成像和(内窥镜)超声引导活检。治疗策略取决于BTC亚型和疾病阶段。对于局部疾病,建议手术后辅以卡培他滨。迄今为止,没有新辅助治疗得到验证。顺铂-吉西他滨化疗联合抗PD-L1抑制剂Durvalumab是晚期疾病的一线治疗标准。建议早期系统肿瘤分子谱分析来筛选可行的改变(IDH1突变,FGFR2重排,HER2扩增,BRAFV600E突变,MSI/dMMR状态,等。)并指导后续的治疗路线。在没有可操作的改变的情况下,FOLFOX化疗是唯一的二线标准治疗。迄今为止,尚无三线化疗标准。
结论:这些指南旨在为日常临床实践提供个性化的治疗策略。每个BTC案例都应由多学科团队讨论。
BACKGROUND: This document is a summary of the French intergroup
guidelines of the management of biliary tract cancers (BTC) (intrahepatic, perihilar and distal cholangiocarcinomas, and gallbladder carcinomas) published in September 2023, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org).
METHODS: This collaborative work was conducted under the auspices of French medical and surgical societies involved in the management of BTC. Recommendations were graded in three categories (A, B and C) according to the level of scientific evidence until August 2023.
RESULTS: BTC diagnosis and staging is mainly based on enhanced computed tomography, magnetic resonance imaging and (endoscopic) ultrasound-guided biopsy. Treatment strategy depends on BTC subtype and disease stage. Surgery followed by adjuvant capecitabine is recommended for localised disease. No neoadjuvant treatment is validated to date. Cisplatin-gemcitabine chemotherapy combined to the anti-PD-L1 inhibitor durvalumab is the first-line standard of care for advanced disease. Early systematic tumour molecular profiling is recommended to screen for actionable alterations (IDH1 mutations, FGFR2 rearrangements, HER2 amplification, BRAFV600E mutation, MSI/dMMR status, etc.) and guide subsequent lines of treatment. In the absence of actionable alterations, FOLFOX chemotherapy is the only second-line standard-of-care. No third-line chemotherapy standard is validated to date.
CONCLUSIONS: These
guidelines are intended to provide a personalised therapeutic strategy for daily clinical practice. Each individual BTC case should be discussed by a multidisciplinary team.