体外药敏试验指导的恶性脑胶质瘤预见性化疗  

Chemotherapy for malignant glioma patients based on in vitro chemo-sensitivity assay

作　　者：陈建文[1] 张俊平[2] 程金建[3] 陈建良[4] 史鸿浏[3] 张俊英[3] 牟永告[2] 张湘衡[2] 周旺宁[2] 赛克[2] 陈忠平[2] 

机构地区：[1]广东省深圳市罗湖区人民医院神经内科,518001 [2]中山大学肿瘤防治中心神经外科,广州510060 [3]中山大学肿瘤研究所神经肿瘤研究室,广州510060 [4]暨南大学附属第二医院

出　　处：《广东医学》2005年第9期1183-1185,共3页Guangdong Medical Journal

基　　金：国家自然科学基金(编号:30271329);华南肿瘤学国家重点实验室基金资助(编号:985-Ⅱ);深圳市科技计划项目(编号:200204154)

摘　　要：目的探讨体外药敏试验指导恶性脑胶质瘤化疗的临床效果及意义。方法对恶性脑肿瘤标本常规采用MTT法进行7种化疗药物体外药敏试验,以指导临床化疗方案的制定。将临床化疗效果与体外药敏结果相比较,分析二者间的符合情况。结果对147例人脑恶性肿瘤手术标本进行体外药敏试验,获得药敏结果的85例,其体外药敏的总成功率58%,早期阶段成功率只有33%,后期到达82%。其中68例为恶性胶质瘤,31例接受化疗。进入疗效评价的共22例,共化疗84个周期,平均3.8个周期。采用一个化疗方案化疗者17例,2个方案化疗者3例,3个方案化疗者2例,总计疗效评价29例次。体外药敏试验结果与临床治疗效果的总符合率为82.8%,阳性符合率为71.4%,阴性符合率为93.3%。体外药敏试验预示的敏感性为90.9%,特异性为77.8%。根据药敏试验结果进行化疗的临床结果:完全缓解(CR)2例,部分缓解(PR)2例,稳定(SD)6例,进展(PD)4例,客观有效率为(CR+PR)为28.6%,疾病控制率为(CR+PR+SD)为71.4%;药敏试验没有发现敏感药物者(凭临床传统用药)组无CR、PR,SD1例,PD14例,客观有效率为0%,疾病控制率为(CR+PR+SD)为6.7%。客观有效率及疾病控制率在药敏试验敏感组显著高于耐药组(P<0.05)。结论MTT体外药敏试验对排除无效药物、筛选敏感药物进行个体化的化疗,提高临床化疗效果,具有重要意义。Objective To investigate the role of in vitro chemo- sensitivity assay in guiding chemotherapy for glioma patients. Methods By utilizing MTT assay, response of malignant brain tumor to seven chemotherapeutic agents was determined in vitro, and the results used to guid chemotherapy for individual patiem. The clinical outcomes were compared to the results of in vitro assay. Results Cytotocixity assay was performed for 147 malignant brain tumor specimens and succeed in 85 cases. The success rate was 58% （33% at early period and 82% for the later stage）. Among 68 malignant glioma patients, 31 received chemotherapy according to the in vitro chemo - sensitivity assay, and 22 cases achieved evaluation criterion. Total of 84 cycles were performed with 3.8 cycles for each patients. Only one regimen was used in 17 cases, while 3 cases received 2 regimens and 2 cases received 3 regimens. 29 cases/causes were evaluated. Total conformity between in vitro and clinical results was 82.8 %. The positive predictive value of in vitro assay was 71.4%, negative predictive value was 93.3%, sensitivity was 90.9% and specificity was 77.8%. Clinical outcome of the patients receiving chemotherapy according to in vitro assay （sensitive group） was as following： complete response（CR）, 2 cases; partial response （PR）, 2 cases; stable disease （ SD ）, 6 eases, and progressive disease（PD）, 4 cases. Objective response（CR ＋ PR） was 28.6% while disease control（CaR＋ PR＋ SD） was 71.4%. However, there was no CR and PR, only 1 case was SD but 14 were PD in patients who revealed insensitive by in vitro assay but treated by conventional regimen（resistant group）. Objective response was 0 and disease control was only 6.7% in the resistant group which was significantly poorer than that in sensitive group （ P 〈 0.05 ）. Conclusion MTT assay for determining sensitivity of chemotherapeutic agents in vitro may provide information to avoid ineffective chemotherapy and indentity efficient agent for chemotherapy.

关 键 词：体外药敏试验 恶性脑胶质瘤 预见性化疗 试验指导 毒副作用 

分 类 号：R739.4[医药卫生—肿瘤] R730.53[医药卫生—临床医学]