ATP-TCA技术指导浅表性膀胱癌术后灌注化疗的临床应用

Application of ATP-TCA assay in intravesical chemotherapy for superficial bladder cancer

目的:探讨生物荧光体外肿瘤药敏检测技术(ATP-TCA)在浅表性膀胱癌肿瘤细胞药敏试验中的应用,探讨该技术在指导膀胱癌个体化治疗上的应用价值。方法:对40例浅表性膀胱癌标本进行肿瘤细胞分离,原代培养,应用ATP-TCA技术检测肿瘤标本对五种常用化疗药物的敏感率和耐药率。试验组术后选用最敏感的化疗药物对患者常规行膀胱灌注化疗,对照组选择丝裂霉素进行术后常规化疗。术后随访2年,评价两组膀胱癌复发情况。结果:40例标本中,吡柔比星(THP)、羟基喜树碱(HCPT)、丝裂霉素(MMC)、表柔比星(EPI)、吉西他滨(GEM)的敏感率分别为75.0%、10.0%、5.0%、37.5%、10.0%,肿瘤细胞对五种化疗药物的敏感率和耐药率差异有统计学意义(P<0.01)。膀胱肿瘤对化疗药物的敏感性存在个体差异。术后随访2年,药敏组膀胱癌复发率为17.5%(7/40),对照组膀胱癌复发率为37.5%(15/40)。两组肿瘤复发率差异有统计学意义(P<0.05)。结论:应用ATP-TCA技术检测出的药敏结果能够反映个体对化疗药物的敏感性,可以作为选择灌注化疗用药的理论基础,指导临床用药进行个体化治疗。同时,应用ATP-TCA技术指导临床膀胱癌术后灌注化疗,可显著降低浅表性膀胱癌患者术后复发率,提高临床疗效。

Objective： To evaluate the feasibility of ATP-TCA for the guide of drug selection in those patients who received intravesical chemotherapy to prevent the recurrence of superficial bladder cancer after operation. Method： Forty superficial bladder cancer samples which received TUR-Bt were enrolled in the present study. Fresh bladder tumor specimens were collected, and the tumor cells and primary culture cells were separated. Then ATP-TCA assay was used to evaluate the chemosensitivity to common anticancer drugs using. The patients were given individualized treatment according to the drug sensitivity. The progression of disease was followed up. Result： The sensitivity proportions of the 40 tumors for THP, HCPT, MMC, EPI and GEM were 75.0%, 10.0%, 5.0%, 37.5% and 10.0% respectively. It showed statistical significance （P〈0.01）. The study also demonstra- ted individual differences between bladder cancer and the sensitivity of chemotherapeutic agents. The recurrence rate of ATP-TCA group and control group were 17. 5 % （7/40） and 37.5 % （15/40） respectively, the recurrence rate have significant difference （P〈0.05）. Conclusion： ATP-TCA assay for drug sensitivity test in vitro might provide experimental basis for clinical individual chemotherapy of superficial bladder cancer. Moreover, individualized treatment after test with ATP-TCA can diminish the recurrence rate of superficial bladder cancer.