三磷酸腺苷-肿瘤体外药敏试验在预测原发性卵巢上皮癌化疗敏感性中的应用价值

Application of ATP-tumor chemosensitivity assay in primary epithelial ovarian cancer

目的 研究三磷酸腺苷-肿瘤体外药敏试验（ATP-TCA）技术在预测原发性卵巢上皮癌化疗敏感性中的应用价值,探讨术前新辅助化疗对卵巢上皮癌术后临床化疗敏感性的影响.方法 回顾性分析59例既往行ATP-TCA检测的原发性卵巢上皮癌患者的临床和随访资料.采用敏感指数（SI）法判定ATP-TCA检测结果,采用卡方检验分析ATP-TCA检测结果与临床化疗敏感性之间的相关性,采用Kaplan-Meier法计算患者的无进展生存时间（PFS）和总生存时间（OS）,采用Logistic回归和卡方检验分析新辅助化疗与临床化疗敏感性的相关性.结果 以SI=250为截点,59例患者中,体外耐药20例,体外敏感39例;ATP-TCA检测技术预测临床化疗耐药的灵敏度、特异度、阳性预测值和阴性预测值分别为91.6%、73.9%、84.6%和85.0%.ATP-TCA检测结果与临床化疗敏感性显著相关（χ^2=26.9,P〈0.001）.体外敏感组患者的复发风险显著低于体外耐药组（P=0.030,OR=0.033,95%CI为0.002～0.724）.体外敏感组患者的中位PFS和OS分别为26和39个月,均较体外耐药组患者的PFS（10个月）和OS（25个月）显著延长（均P〈0.01）.新辅助化疗与临床耐药具有显著的相关性（χ^2=15.214,P〈0.001）.结论 ATP-TCA检测技术可有效预测原发性卵巢上皮癌化疗药物的临床化疗敏感性,可作为预测卵巢上皮癌早期复发的有效检测方法.

Objective To evaluate the predictive value of the adenosine triphosphate-tumor chemosensitivity assay （ATP-TCA） in the chemotherapy applied in primary epithelial ovarian cancer （PEOC） , and to analyze if the neoadjuvant chemotherapy have any influence on the postoperative chemosensitivity. Methods ATP-TCA results from 61 PEOC specimens were analyzed retrospectively.Patients were divided into sensitive group and resistant group according to the ATP-TCA results. Sensitive index （SI） was applied to analyze the ATP-TCA results. The correlation between in vitro results and clinical outcome was assessed by univariate and multivariate analysis. Results SI set at 〉 250 had the highest test sensitivity, specificity, positive and negative predictive value of 91.6% , 73.9% , 84.6% and 85.0% ,respectively. The ATP-TCA results had significant correlation with clinical outcome （χ^2= 26.9,P 〈0.001）. Patients with tumors shown to be resistant had a higher risk of recurrence in comparison with those who were tested as sensitive （P=0.030, OR = 0.033,95% CI 0.002～0.724）. The median progression-free survival （PFS） and overall survival （OS） of in vitro-sensitive patients were 26 months and 39 months, respectively, significantly longer than those in the in vitro drug-resistant group of patients （ PFS 10 months and OS 25 months） （both P 〈 0. 01）. Neoadjuvant chemotherapy had a significant correlation with the clinical chemoresistance （χ^2=15.214,P〈0.001）. Conclusion ATP-TCA assay may effectively predict the chemosensitivity of primary ovarian cancer, and predict the early recurrence of the tumor.