应用ATP生物荧光肿瘤体外药敏检测技术研究大肠癌药敏的异质性.doc

应用ATP生物荧光肿瘤体外药敏检测技术(ATP-TCA) 研究大肠癌药敏的异质性 田海梅1 李艳芬1 吴健雄2 曹冬艳1 荣维淇2 刘毅1 李茉1 王海鹏2 王小兵1 张伟1#中国医学科学院肿瘤医院肿瘤所 1 生物检测中心 2 腹部外科，北京 100021 摘要：目的 探讨用ATP生物荧光肿瘤体外药敏检测技术（ATP-TCA）研究大肠癌药敏的异质性和个体化疗的可行性。 方法 用ATP-TCA检测58例大肠癌标本对16种单药或联合用药的敏感性。结果 个体之间的药物敏感性存在着明显的异质性。单药中最有效的药物为长春瑞滨、羟基喜树碱、氟尿嘧啶和紫杉醇。联合用药最有效的是氟尿嘧啶+丝裂霉素+阿糖胞苷，91.6%（11/12）的标本对其敏感，其次是氟尿嘧啶+顺铂+阿霉素, 健择+顺铂和5-FU氟尿嘧啶+长春新碱+卡氮芥。结论 大肠癌对抗癌药物的敏感程度存在着异质性。ATP生物荧光肿瘤药敏检测技术可用于为大肠癌选择合适的化疗药物。关键词: ATP生物荧光肿瘤药敏检测技术 大肠癌 Heterogeneity of chemosensitivity of colorectal cancer determined by an ex vivo ATP-tumor chemosensitivity assay [Abstract] Objective To investigate the heterogeneity of chemosensitivity in colorectal cancer using an ATP-tumor chemosensitivity assay (ATP-TCA) and the feasibility of individual chemotherapy. Methods An ATP-TCA were used to determine the effect of 16 single or combined cytotoxic drugs in surgical specimens from 58 patients with colorectal cancer cancer. Results There were considerable differences in chemosensitivitvy between individuals.The most active single drugs in the assay was identified as Navelbine, Hydroxycamptothecin, 5-Fluorouracil and Paclitaxel. 5-Fluorouracil+Mitomycin+Aytarabine was found to be the most effective combination in, for 91.6% （11/12）specimens were sensitive to this regimen. 5-Fluorouracil+Cisplatin+Adriamycin, Gemcitabine+ Cisplatin and 5-Fluorouracil +Vincristine+Carmustine were moderately active regimens. Conclusions There was the heterogeneity of the in vitro chemosensitivity in colorectal cancer. The use of the ATP-TCA provides a method of selecting appropriate anti-cancer drugs in colorectal cancer. [Key words] ATP-TCA; colorectal cancer ??? 大肠癌是常见的肿瘤之一，属化疗中度敏感类肿瘤。由于发现时多已属中、晚期，术后需辅助化疗。每个病人对不同化疗药的敏感性不同，在化疗前为病人筛选出敏感性药物，进行个体化治疗，有助于提高化疗的疗效。本研究采用现在较为先进的ATP生物荧光肿瘤体外药敏检测技术（ATP-TCA），对58例新鲜大肠癌手术标本进行药敏检测。 1 材料与方法1.1 临床资料??? 58例标本取自本院2002年3月－2004年7月就诊的大肠癌病人，其中57例是手术标本，1例是结肠癌皮下转移的活检标本。均经病理学证实为大肠癌，其中结肠癌21例（腺癌20例，印戒细胞癌1例），直肠癌（腺癌）37例；TNM分期为I-II期32例，III期25例，IV期1例。病人中男性33人，女性25人；年龄30－81岁，中位年龄58岁。术前1人接