药物敏感试验指导胃癌合并恶性腹水的腹腔内化疗

Intraperitoneal chemotherapy for malignant ascites of gastric cancer based on the results of in vitro drug sensitivity test of anticancer agents

目的用药物敏感试验预测胃癌腹水癌细胞对抗癌药物的敏感性,观察其在指导胃癌合并恶性腹水腹腔内化疗的价值。方法选择47例腹水癌细胞阳性胃癌患者,随机分离19例的腹水癌细胞,用三磷酸腺苷(ATP)法分别检测其对卡铂、泰素、5氟尿嘧啶、顺铂、阿霉素、羟基喜树碱、甲氨蝶呤、丝裂霉素、氮烯咪胺的敏感性,各选择最敏感的1种药物对患者进行腹腔内化疗。观察治疗后腹水完全缓解率、腹水癌细胞转阴率,并与28例顺铂单药腹腔内化疗组比较。结果19例腹水癌细胞对抗癌药物敏感的例数分别为卡铂7例、泰素6例、5氟尿嘧啶6例、顺铂6例、阿霉素5例、羟基喜树碱5例、丝裂霉素5例,对甲氨蝶呤和氮烯咪胺均不敏感。治疗后药物敏感试验组腹水完全缓解率为57.9%,高于顺铂组的28.6%(P<0.05);药物敏感试验组腹水中癌细胞转阴率为68.4%,高于顺铂组的32.1%(P<0.05)。结论用药物敏感试验指导胃癌合并恶性腹水腹腔内个体化化疗,可提高恶性腹水的完全缓解率和腹水中癌细胞转阴率,该治疗方法具有临床实用价值。

Objective To estimate the sensitivity of malignant cells from ascites of gastric cancer to anticancer agents by in vitro sensitivity test, and to study its value in individualized intraperitoneal chemotherapy. Methods Forty-seven cases of gastric cancers with malignant ascites were selected. The gastric cancer cells were isolated from the ascites of 19 patients with gastric cancers, and in vitro sensitivity tests to carboplatin, taxol, fluorouracil, cisplatin, adriamycin, hydroxycamptothecine, methotrexate, mitomycin and dacarbazine were performed by ATP bioluminescence assay. One of the most sensitive drugs was applied to intraperitoneal chemotherapy. The rates of the patients with complete remission of ascites and with disappearance of intraperitoneal cancer cells in the sensitivity test group were compared to those of 28 patients in control group who all were treated with intraperitoneal cisplatin. Results In sensitivity test group, the sensitive cases to carboplatin, taxol, fluorouracil, cisplatin, adriamycin, hydroxycamptothecine, and mitomycin were 7,6,6,6,5,5 and 5 respectively. No case was sensitive to methotrexate or dacarbazine. The rates of patients with complete remmission of ascites and the rates of patients with disappearance of intraperitoneal cancer cells in the sensitivity test group were significantly higher than those in cisplatin control group(68.4% vs. 32.1%, P<0.05, and 57.9% vs. 28.6% P<0.05).Conclusions Individualized intraperitoneal chemotherapy based on the results of drug sensitivity test could improve the therapeutic efficacy of malignant ascites from gastric cancer.