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目的:比较晚期胆道系统肿瘤患者一线及二线不同化疗方案的疗效并分析其预后相关因素。方法:回顾分析中国医学科学院肿瘤医院2011年1月至2018年12月收治的晚期胆道系统肿瘤患者资料。评估化疗疗效，计算客观缓解率(ORR)、疾病控制率(DCR)。随访预后情况。采用Cox比例风险模型分析患者预后影响因素。结果:共入选151例患者，男性75例，女性76例，年龄范围31～77岁，中位年龄58岁。一线化疗方案分为含吉西他滨方案(联合铂类和/或氟尿嘧啶类)或铂类联合氟尿嘧啶类方案共104例，白蛋白紫杉醇联合替吉奥(AS)方案共47例，ORR分别为15.4%(16/104)和27.6%(13/47)，DCR分别为65.4%(68/104)和72.3%(34/47)。可分析的二线化疗患者共58例，其中吉西他滨、铂类、氟尿嘧啶三类药物为基础的方案31例，ORR为3.2%(1/31)，DCR为35.5%(11/31)；以紫杉类药物为基础的方案18例，ORR为11.1%(2/18)，DCR为38.9%(7/18)；以伊立替康为基础的方案9例，ORR为22.2%(2/9)，DCR为44.4%(4/9)。单因素分析，肝转移及糖类抗原(CA)19-9升高的患者生存时间较短(n HR＝1.540，95%n CI：1.019～2.328，n P＝0.040；n HR＝1.892，95%n CI：1.123～3.188，n P＝0.017)。n 结论:对于晚期胆道系统肿瘤患者，除了传统的吉西他滨、氟尿嘧啶类、铂类药物的组合方案外，AS是一线化疗的有效方案。二线化疗比例低且作用有限，含伊立替康方案值得进一步探索。肝转移、CA19-9升高与晚期胆道系统肿瘤患者预后不良相关。“,”Objective:To study the efficacy of different systemic chemotherapy regimens as first-line and second-line therapy and to determine the prognostic factors for patients with advanced biliary tract cancer.Methods:The clinical data of patients with advanced biliary tract cancer who underwent systemic chemotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2018 were studied. The efficacy of chemotherapy on objective response rate (ORR) and disease control rate (DCR) were evaluated. Potential prognostic factors for survival were studied using the Cox proportional hazards models.Results:Of 151 patients enrolled into this study, there were 75 males and 76 females, with ages ranging from 31 to 77 years (median 58 years). Two treatment protocols were used: (1) 104 patients received a gemcitabine-based regimen (combined with platinums or fluorouracils) or a combination of platinums and fluorouracils, while (2) 47 patients received a combination of albumin-bound paclitaxel and S-1. The corresponding ORR for each group were 15.4%(16/104) and 27.6%(13/47), respectively, and the DCR were 65.4%(68/104) and 72.3%(34/47), respectively. Of 58 evaluable patients who received chemotherapy as a second-line therapy, 31 patients received the regimen containing gemcitabine, platinums or fluorouracils with an ORR of 3.2% (1/31) and a DCR of 35.5%(11/31); a total of 18 patients received the taxanes-based regimen with an ORR of 11.1%(2/18) and a DCR of 38.9%(7/18); 9 patients received the irinotecan-based regimen with an ORR of 22.2%(2/9) and a DCR of 44.4%(4/9). Univariate analysis showed positive liver metastasis and elevated carbohydrate antigen (CA)19-9 level to be significantly correlated with worse survival outcomes (n HR=1.540, 95%n CI: 1.019-2.328, n P=0.040 and n HR=1.892, 95%n CI: 1.123-3.188, n P=0.017).n Conclusion:For patients with advanced biliary tract cancer, in addition to the conventional regimens containing gemcitabine, platinums and fluorouracils, the combination of albumin-bound paclitaxel and S-1 was shown to be an effective chemotherapeutic regimen for these patients. Second-line chemotherapy was insufficient and ineffective, and an irinotecan-based regimen deserves to be further investigated. Liver metastasis and elevated CA19-9 level were worse prognosis after chemotherapy for patients with advanced biliary tract cancer.