IDH1基因检测联合CD-DST药敏指导胶质瘤术后辅助化疗的临床应用分析  

Clinical Application of IDH1 Mutations and CD-DST Technology in Adjuvant Chemotherapy in Gliomas

作　　者：张烨[1] 孙佩欣[1] 隋锐[1] 梁海洋[1] 张桂荣[1] 朴浩哲[1] ZHANG Ye;SUN Pei-xin;SUI Rui(Cancer Hospital of China Medical University,Liaoning Cancer Hospital ＆ Institute ,Shenyang 110042,China)

机构地区：[1]中国医科大学附属肿瘤医院辽宁省肿瘤医院

出　　处：《肿瘤学杂志》2018年第3期226-229,共4页Journal of Chinese Oncology

基　　金：辽宁省省直临床建设项目(LNCCC-B04-2015);辽宁省科学事业公益研究基金(2014001008);辽宁省中央引导地方科技发展专项项目(2017106014)

摘　　要：[目的]研究胶质瘤中异柠檬酸脱氢酶1（isocitrate dehydrogenases 1,IDH1）突变和胶滴肿瘤药敏检测技术（CD-DST）结果的关联性及指导术后辅助化疗方案的疗效分析。[方法]收集手术切除并经病理证实的高级别脑胶质瘤组织57例,新鲜标本分别对替莫唑胺等5种化疗药物进行CD-DST检测指导治疗方案,同时采用直接测序法检测肿瘤组织中IDH1基因突变情况,分析两者相关性。以CD-DST检测结果为指导治疗患者57例,比较16例行指导规范治疗与未行指导规范治疗患者的生存情况。[结果]57例高级别脑胶质瘤患者中IDH1突变13例（22.8%）,IDH1突变患者中位总生存时间显著性优于IDH1未突变患者（12.0个月vs 7.5个月,P=0.002）。IDH1突变患者的替莫唑胺、Vp-16、卡铂和卡莫司汀的体外敏感率高于无IDH1突变的患者,而顺铂敏感性在有无突变组差异无统计学意义。CD-DST指导的行规范治疗与未行规范治疗患者的中位总生存时间分别为12个月和8个月,差异无统计学意义（P〉0.05）。IDH1突变联合CD-DST敏感指导规范治疗患者的中位总生存时间为14个月,显著性优于其他组别（P=0.019）。[结论 ]IDH1基因检测联合CD-DST技术对于高级别脑胶质瘤术后辅助化疗方案具有一定的临床指导价值。[Objective]To investigate the relationship between isocitrate dehydrogenase 1（IDH1）mutations and the feasibility of collagen gel droplet-embedded culture drug sensitivity test（CD-DST）in adjuvant chemotherapy in gliomas.[Methods]The surgery specimens of 57 patients with high grade gliomas were collected and carried out the CD-DST test for temozolomide and other drugs.IDH1 mutations were detected by direct squencing method.Compared with control,16 patients were included in pilot group receiving chemotherapy guided by CD-DST.Overall survival was compared between the pilot group and control group.[Results]IDH1 mutations were demonstrated in 13 of 57 cases（22.8%）.Median overall survival was superior in IDH1 mutant group than that in IDH1 wild group（12.0 months vs 7.5 months,P=0.002）.The sensitivity of temozolomide,Vp-16,carboplatin and carmustine were higher in IDH1 mutant group than that in IDH1 wild group.No difference was found in sensitivity of cisplatin between the two groups.The median overall survival were 12 months and 8 months in pilot and control group（P〉0.05）.The median overall survival were longest in patients with guided by IDH1 mutation combined with CD-DST（14 months）than other groups.[Conclusion]IDH1 mutant detection combined with CD-DST technology has a certain value in adjuvant chemotherapy in high grade gliomas.

关 键 词：胶质瘤 异柠檬酸脱氢酶1 胶滴肿瘤药敏检测技术 替莫唑胺 

分 类 号：R739.41[医药卫生—肿瘤]