三磷酸腺苷-肿瘤体外药敏试验预测复发性卵巢上皮癌化疗敏感性的价值

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

目的 探讨三磷酸腺苷-肿瘤体外药敏试验（ATP-TCA）在复发性卵巢上皮癌个体化治疗中的价值,评价体外药敏结果与临床化疗敏感性的相关性.方法 回顾性分析69例既往行ATP-TCA检测的复发性卵巢上皮癌患者的临床资料,根据ATP-TCA检测结果将患者分为体外对药物高度敏感组、中度敏感组和耐药组.临床疗效的评估以影像学检查等结果为依据.采用x2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法分析经药敏指导治疗后患者的无进展生存时间（PFS）和总生存时间（OS）.结果 ATP-TCA检测结果与临床化疗疗效之间有显著的相关性,即随着体外药物敏感性的增高,体内化疗的疗效越佳（x2=9.066,P=o.004）.ATP-TCA检测结果预测药物治疗复发性卵巢上皮癌临床化疗敏感性的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为87.5%、45.9%、58.3%、80.9%和65.2%.体外高度敏感组、中度敏感组和耐药组患者经药敏指导治疗后的PFS平均值分别为187.1、195.0和60.3 d,OS平均值分别为476.7、335.7和237.5 d,两个体外敏感组患者的PFS和OS均显著长于体外耐药组（P＜0.01）.结论 ATP-TCA检测结果与患者的临床治疗反应之间有很好的相关性,是开展肿瘤个体化化疗的一种有效的体外药物筛选方法.

Objective To explore the value of adenosine triphosphate-tumor chemosensitivity assay （ATP-TCA） in individualized treatment of recurrent epithelial ovarian cancer （ REOC）, and to evaluate the correlation between the in vitro chemosensitivity assay and clinical drug sensitivity. Methods Sixty-nine REOC specimens were tested by ATP-TCA assay retrospectively. The patients were divided into strong sensitive, moderate sensitively and resistant groups according to the ATP-TCA assay results. The clinical results were evaluated according to imaging and serum CA125 analysis. The correlation between in vitro ATP-TCA assay and clinical outcome was statistically analyzed by x2 test. The progression free survival （PFS） and overall survival （OS） of each group were analyzed using Kaplan-Meier method. Results The results of ATP-TCA assay had significant correlation with clinical outcome. The clinical chemotherapy outcome became better with increased drug sensitivity in vitro （x2 = 9. 066, P = 0. 004 ）. The sensitivity,specificity, positive predictive value, negative predictive value and accuracy rate for ATP-TCA method to predict the clinical chemotherapy sensitivity of REOC were 87.5%, 45.9%, 58.3%, 80.9% and 65.2%,respectively. The mean PFS of strong sensitive group, moderately sensitive group and resistant group were 187.1 days, 195.0 days and 60.3 days, respectively. The mean OS were 476.7, 335.7 and 237.5 days,respectively, following the start of TCA-directed therapy. The PFS and OS of the two sensitivity groups in vitro were significantly longer than that of the in vitro-resistant group （P 〈 0. 01 ）. Conclusion The results of ATP-TCA assay are well correlated with clinical treatment responses. The assay may be an important and useful method for individualized chemotherapy for recurrent ovarian cancer.