三磷酸腺苷-肿瘤体外药敏试验指导复发性卵巢上皮性癌化疗的前瞻性研究  

A prospective study of adenosine triphosphate-tumor chemosensitivity assay directed chemotherapy in patients with recurrent ovarian cancer

作　　者：高玉涛[1] 吴令英[1] 张伟[2] 赵丹[1] 李宁[1] 田海梅[2] 王小兵[2] 李茉[2] 孙阳春[1] 李楠[1] 李晓光[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院妇瘤科,100021 [2]中国医学科学院北京协和医学院肿瘤医院生物检测中心,100021

出　　处：《中华妇产科杂志》2013年第5期358-363,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市科学技术委员会计划（Z101107050210028）

摘　　要：目的探讨以三磷酸腺苷（ATP）一肿瘤体外药敏试验（TCA）指导复发性卵巢上皮性癌（卵巢癌）化疗的价值。方法采用前瞻性对照研究方法，收集中国医学科学院北京协和医学院肿瘤医院2010年8月至2012年6月问收治的符合下述纳入条件的复发性卵巢癌患者，纳入条件：（1）既往病理检查确诊为卵巢癌；（2）复发合并恶性胸腹水，或者有临床可评价的复发病灶接受再次手术能取得标本的患者；（3）Karnofsky功能状态（KPS）评分60—100分，能够耐受化疗；（4）预计生存时间〉6个月。根据患者意愿分为两组，药敏组：在ATP—TCA指导下化疗；对照组：行常规化疗而未予ATP—TCA。对两组患者的临床病理指标、化疗有效率及无进展生存时间（PFS）进行比较。结果本研究共收录113例复发性卵巢癌患者，其中药敏组56例，对照组57例。药敏组患者的中位年龄为54岁（23—78岁），对照组患者的中位年龄为53岁（28—72岁），两组比较，差异无统计学意义（P=0．591）。两组患者的复发类型、手术病理分期、病理类型、病理分化程度、复发次数、二次肿瘤细胞减灭术后残留灶大小比较，差异均无统计学意义（P〉0．05）。药敏组患者的化疗有效率为66％（37／56）、中位PFS为7个月，对照组分别为46％（26／57）、4个月，两组患者的化疗有效率和中位PFS分别比较，差异均有统计学意义（P=0．037，P=0．040）。药敏组中铂类耐药型患者的化疗有效率为59％（16／27）、中位PFS为5个月，对照组分别为25％（7／28）、2个月，两组中铂类耐药型患者的化疗有效率和中位PFS分别比较，差异均有统计学意义（P=0．010，P=0．003）。结论ATP—TCA指导下的化疗，可以提高复发性卵巢癌患者特别是其中铂类耐药型患者的化疗有效率及PFS。Objective To investigate the efficacy of adenosine triphosphate （ATP）-tumor chemosensitivity assay （TCA） directed chemotherapy in patients with recurrent epithelial ovarian cancer. Methods From August 2010 to June 2012, recurrent epithelial ovarian cancer patients were prospectively enrollmented in Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. The entry criteria are as follows ： （ 1 ） Histologically proven to be epithelial ovarian cancer. （2） Patients of recurrent ovarian cancer with bidimensionally measurable tumor, or ascitic or pleural fluid for testing. （3） Kamofsky performance status 〉 60. （4） A life expectancy of at least more than 6 months. According to patients desires, they were assigned into two groups：assay-directed therapy group and physician＇s-choice therapy group, patients＇ clinical and pathological characteristics, response rate to chemotherapy and progression-free survival （PFS） were compared between two groups. Results A total of 113 patients with recurrent epithelial ovarian cancer were prospectively enrollmented to assay-directed chemotherapy （ n = 56） or physician＇s-choice chemotherapy （ n = 57）. There was no difference in median age, types of recurrence, surgical-pathological stage, pathological type, tumor grade, times of recurrence, residual disease at secondary cytoreductive surgery between assay-directed group and physician＇ s-choice group. The overall response rate（ORR） and median PFS in the ATP-TCA group was 66% （37/56）and 7 months, while the ORR in the control group was 46% （26/57, P = 0. 037 ）, the median PFS was 4 months （P = 0. 040）. For platinum-resistant patients, the ORR between ATP-TCA directed chemotherapy 59% （16/27） and control group 25% （7/28） were significantly different （P = 0. 010） , and the median PFS between two groups were also significantly different （ 5 months and 2 months, respectively, P = 0. 003）. Conclusion ATP-TCA directed chemotherapy could im

关 键 词：卵巢肿瘤 肿瘤复发 局部 腺苷三磷酸 药物筛选试验 抗肿瘤 前瞻性 研究 

分 类 号：R737.31[医药卫生—肿瘤]