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Gastroenterologie up2date 2017; 13(04): 351-362
DOI: 10.1055/s-0043-118091
Leber/Galle/Pankreas
Georg Thieme Verlag KG Stuttgart · New York

Gallengangskarzinome

Martha M. Kirstein
,
Arndt Vogel
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Publikationsverlauf

Publikationsdatum:
08. Dezember 2017 (online)

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Gallengangskarzinome sind die zweithäufigsten malignen primären Lebertumoren nach dem hepatozellulären Karzinom. Patienten mit Gallengangskarzinomen haben eine sehr schlechte Prognose: eine 5-Jahres-Überlebensrate von unter 20% und ein medianes Gesamtüberleben von 12 – 15 Monaten [1], [2]. Dieser Beitrag fasst die Epidemiologie und die evidenzbasierten therapeutischen Optionen von Patienten mit Gallengangskarzinomen zusammen.
Kernaussagen

  • 3% aller gastrointestinalen Tumoren sind Gallengangskarzinome. 70% der Gallengangskarzinome treten sporadisch auf.

  • Darüber hinaus sind die wichtigsten Risikofaktoren in der westlichen Hemisphäre die primär sklerosierende Cholangitis und in Asien die parasitäre Infektion mit Leberegeln.

  • Risikopatienten sollten durch eine Kombination aus Bildgebung (Sonografie, MRCP, CT), Endoskopie und Biomarkern regelmäßig überwacht werden.

  • Patienten mit Gallengangskarzinomen haben eine fatale Prognose. Die einzige Therapie mit Chance auf Kuration ist die Resektion. Die Rezidivraten nach Resektion sind jedoch hoch.

  • Phase-III-Studien zeigten, dass eine adjuvante Chemotherapie das rezidivfreie Überleben und das Gesamtüberleben verlängert.

  • In der palliativen Situation ist eine Chemotherapie mit Gemcitabin und Cisplatin der Standard der Erstlinientherapie.

  • Prospektiv randomisierte Phase-III-Daten zu systemischen Zweitlinienoptionen liegen derzeit nicht vor. Auf der Basis von Phase-II- und retrospektiven Daten sowie einer Metaanalyse kann eine 5-FU-basierte Chemotherapie angeboten werden.

  • Zielgerichtete und Immuntherapien stehen aktuell im Fokus der Forschung.

Schlüsselwörter

primär sklerosierende Cholangitis - adjuvante Chemotherapie - palliative Erstlinientherapie - palliative Zweitlinientherapie - Immuntherapie
 

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