乳腺癌体外药敏实验结果分析及价值

目的 探讨肿瘤体外药敏实验对乳腺癌个体化化疗的应用价值.方法 采用组织块培养-终点染色-计算机图像分析(TECIA)法检测38例乳腺癌对6种常用化疗药物的体外肿瘤药物敏感性.结果 38例乳腺癌组织对化疗药物的敏感性由高到低依次为: 多柔比星、紫杉醇、长春瑞滨、环磷酰胺、顺铂及氟尿嘧啶.结论 TECIA法的体外肿瘤药敏实验对指导乳腺癌的临床用药及个体化化疗具有重要价值.     

肿瘤化疗敏感试验在肝癌患者个体化疗中的应用

近年来,随着分子及细胞生物学等技术的发展,以个体化疗为目的的肿瘤化疗敏感试验（chemosensitivity test,CST）日益受到重视,进一步提高了肿瘤化疗的效果。本文就当前常用的几种药敏检测方法,肝癌患者肿瘤细胞和外周血淋巴细胞（peripheral blood lymphocyte,PBL）药敏指导临床应用方面的进展做一综述。     

组织培养药敏测试法在表浅膀胱肿瘤化疗药敏测试中的应用价值

目的：探讨Hoffman式组织培养药敏测试法在表浅膀胱癌腔内化疗药敏测试中的应用价值。方法：对31例表浅膀胱癌分别进行Hoffman式组织培养，对丝裂霉素C(MMC)进行改良MTT法药敏测试，检测MMC在浓度为1g/L、作用时间为2h情况下对表浅膀胱癌的生长抑制率。采用MMC 40mg加生理盐水40m1对表浅膀胱癌进行术后标准腔内化疗，并随访20个月。结果：18例培养成功，15例进入药敏测试，其中9例对MMC敏感，6例不敏感。术后腔内化疗随访结果显示敏感者有2例复发，不敏感者有5例复发；单因素Kaplan—Meier生存分析显示敏感者无复发生存率明显高于不敏感者。与临床实际疗效比较，该药敏测试法的特异性为75．0％，敏感性为85．7％，准确率达80．0％。结论：组织培养药敏测试法不仅可以检测表浅膀胱癌对化疗药物的敏感性，还能预测利用敏感药物进行腔内化疗的预后。     

流式细胞术的凋亡检测技术在人胃肠实体瘤药敏试验中的应用

目的化疗药能诱导肿瘤细胞凋亡，据此将流式细胞术的经典凋亡检测技术应用到临床特异性抗肿瘤药物的筛查，实现快速，准确的药物敏感性报告。方法应用流式细胞术的AnnexinV／PI技术，检测67例临床手术切除的胃肠肿瘤在不同化疗药物诱导下发生的凋亡。结果7种化疗药物诱导的胃肠肿瘤凋亡率有显著差异，胃癌的凋亡率以紫杉醇，丝裂霉素，氟尿嘧啶最高；而大肠癌以氟尿嘧啶，丝裂霉素，奥沙利铂诱导的凋亡率最高。联合化疗方案，胃癌以氟尿嘧啶联合紫杉醇的敏感率及凋亡率最高；大肠癌以氟尿嘧啶联合奥沙利铂的敏感率及凋亡率最高。结论不同肿瘤或同一肿瘤的不同个体，对化疗药物的敏感性均不同。临床可应用凋亡检测技术作为快速的药物敏感性检测方法，为肿瘤化疗筛选合适的个体化有效方案，避免无效化疗。     

ATP生物荧光肿瘤药敏检测技术在胰腺癌中的应用

目的探讨ATP肿瘤化疗药敏实验（ATP tumor chemosensitivity assay，ATP—TCA）对胰腺癌化疗药敏测定并指导临床个性化治疗的可行性。方法2003年～2006年，采用ATP—TCA法对40例胰腺癌进行药敏检测。结果对胰腺癌未发现强敏感药物和部分敏感药物，轻度敏感的药物有：吉西他滨（GEM），氟尿嘧啶（5-FU），紫杉醇（PTX），奥沙利铂（OXA）；耐药的药物有：卡铂（DDP），表柔比星（EPI），长春瑞滨（NVB），丝裂霉素（MMC），拓扑替康（TPT），卡莫司汀（BCNU），多西他赛（TXT）。结论ATP—TCA法对胰腺癌进行药敏检测是可行的，但尚未发现胰腺癌强敏感和部分敏感的药物；ATP—TCA法指导胰腺癌个体化治疗的临床疗效有待进一步观察。     

体外药敏试验ATP-TCA与流式细胞仪在肝癌化疗中的应用

目的 探讨体外化疗药敏试验系统（ATP-TCA系统）联合流式细胞仪（FCM）在肝癌化疗中的应用及其结果之间的关系。方法 取24例肝癌切除，活检或穿刺组织行体外药敏试验和流式细胞仪P170检测，并分析二者间的关系。结果 ATP-TCA的可评估率为91.67%;10种化疗药物的敏感率分别为：氟尿嘧啶5.00%，诺消灵5.00%，顺铂14.26%，足叶乙甙19.05%，草酸铂19.05%,丝裂霉素23.81%，表阿霉素28.57%，开普拓45.46%，健择47.62%，泰素63.64%；P170检测阳性率为57.14%；丝裂霉素，表阿霉素的敏感率在P170阴性表达时高，开普拓健择，泰素的敏感率高且在P170阳性表达和阴性表达时无显著差异。结论 ATP-TCA法联合FCM可较好用于肝癌化疗药物的筛选；丝裂霉素，表阿霉素可用于P170阴性表达的病人，开普拓，健择，泰素可用于P170阳性表达的病人。     

ATP-TCA技术在膀胱癌治疗上的应用与进展

生物荧光肿瘤体外药敏检测技术(ATP-TcA)是目前肿瘤体外药敏检测中最先进的药敏检测主流技术.该技术的应用将对提高肿瘤化疗用药的针对性和用药科学性产生重要影响.临床研究和试验结果表明ATP-TCA技术指导的膀胱癌化疗较传统化疗模式更能提高临床疗效,延长病人总生存期和无进展生存期.现对其研究成果和进展作一综述.     

消化道肿瘤淋巴结转移灶体外化疗药敏性的变化及其意义

目的：探讨消化道肿瘤淋巴结转移灶化疗药敏性的变化及其意义。方法： 对40例伴淋巴结转移的胃癌和结直肠癌的原发灶及淋巴结转移灶进行MTT法原代细胞培养化疗药敏性试验, 比较两种病灶对9种化疗药物敏感性的差异。结果：7/9种化疗药物对原发灶和淋巴结转移灶的肿瘤细胞抑制率有差异 (均为P<0.05), 其中HCPT,LOHP,CDDP对转移淋巴结细胞抑制率明显低于原发灶(均为P<0.05), eADM,VP-16,THP,MMC对原发灶肿瘤细胞抑制率明显低于淋巴结转移灶(均为P<0.05)。5-FU,HCPT,LOHP,THP对原发灶和转移淋巴结的肿瘤细胞抑制率呈正相关(r=0.4142~0.5712, 均P<0.05),仅5-FU对两种病灶肿瘤细胞的抑制率无统计学差异(P>0.05)。 结论消化道肿瘤淋巴结转移灶对化疗药物敏感性与原发灶之间存在异质性;肿瘤原发灶对化疗药物敏感性并不能完全反映转移淋巴结的化疗耐药性。     

ATP-TCA技术在膀胱癌治疗上的应用与进展

生物荧光肿瘤体外药敏检测技术(ATP-TcA)是目前肿瘤体外药敏检测中最先进的药敏检测主流技术.该技术的应用将对提高肿瘤化疗用药的针对性和用药科学性产生重要影响.临床研究和试验结果表明ATP-TCA技术指导的膀胱癌化疗较传统化疗模式更能提高临床疗效,延长病人总生存期和无进展生存期.现对其研究成果和进展作一综述.     

ATP-TCA技术在膀胱癌治疗上的应用与进展

生物荧光肿瘤体外药敏检测技术(ATP-TcA)是目前肿瘤体外药敏检测中最先进的药敏检测主流技术.该技术的应用将对提高肿瘤化疗用药的针对性和用药科学性产生重要影响.临床研究和试验结果表明ATP-TCA技术指导的膀胱癌化疗较传统化疗模式更能提高临床疗效,延长病人总生存期和无进展生存期.现对其研究成果和进展作一综述.     

局部进展期及较大乳腺癌的保乳治疗

目的探讨局部进展期及较大乳腺癌的保乳问题。方法对33例肿瘤直径4．1cm以上的乳腺癌患者手术前予以蒽环类为主的联合化疗方案化疗,待肿瘤缩小后行保乳手术。结果33例患者中有3l例接受1～8周期的新辅助化疗,平均3．7个周期。化疗有效率100％,其中临床完全缓解19例,临床部分缓解12例,病理学完全缓解9例。33例保乳手术最终切缘阴性率100％,手术中切除标本切缘快速冰冻病理检查1次阴性率75．8％。全部病例随访2～39个月,中位随访27个月,无一例复发。结论对于局部进展期及较大肿瘤乳腺癌,采用以新辅助化疗为主的综合治疗,多数患者可以成功保乳,近期疗效与小肿瘤患者相近。     

Initial results of combined surgical-medical therapy for metastatic cancer of the stomach]

Fifty patients with advanced gastric cancer underwent chemotherapy in accordance with the FAMTX protocol. Complete tumor remission was achieved in 6 patients and partial remission in 11 patients. In this group 9 patients (tumor stage: T3-4, N2-3, M chi-1) underwent a second-look operation after chemotherapy either to confirm the complete remission or to resect the remaining tumor mass. It is concluded that even in advanced stages of gastric carcinomas a more aggressive approach involving a combination of surgical and chemotherapeutic treatment improves the survival time of these patients.     

Study of consolidation chemotherapy in advanced epithelial ovarian carcinoma

Objective:A prospective randomized study was designed to evaluate the role of consolidation chemotherapy in advanced epithelial ovarian carcinoma.Methods:50 patients with advanced epithelial ovarian carcinoma treated in our hospital during the period from March 2000 to October 2005 were enrolled in this study.All patients had achieved clinical complete remission by means of standard treatments,and were randomly divided into consolidation chemotherapy group and control group.Relapse rate,and disease-free survival(DFS)time were analyzed in both groups.Results:24 patients were assigned in consolidation chemotherapy group,and 26 patients in control group.Tumor relapse interval in consolidation group was(26.5±7.4)months,vs.(16.8±7.0)months in control group respectively,P=0.001.Time to relapse(TTR)in consolidation group was(19.2±6.8)months,vs.(10.0±6.9)months in control group,P=0.002.Analysis of DFS time and overall survival time,Log Rank test:P=0.042 and P=0.062,respectively.Conclusions:Consolidation chemotherapy could be the relevant factor that postpones tumor relapse interval and prolongs DFS time in advanced epithelial ovarian carcinoma patients who had achived chlinical complete remission.But so far the statistic result of our clinical study is beyond the conclusion that consolidation chemotherapy can decrease relapse rate or increase survival rate.Multicenter randomized clinical trial should be performed to confirm the role of consolidation chemotherapy in advanced epithelial ovarian carcinoma.     

Feasibility of subrenal capsule assay as chemosensitivity test for primary esophageal cancer

Subrenal Capsule Assay (SRCA) as a chemosensitivity test was performed on 39 esophageal squamous cell carcinomas in order to select a more effective chemotherapy and assess the correspondence between the assay results and clinical results. The implant grew progressively for six days and decreased from day 7 in the group of control mice. Histologically, host cell infiltration and new vessel was observed from day 3 after transplantation. Tumor growth curve was not influenced by immunosuppression with cyclophosphamide for six days. As primary esophageal squamous cell carcinomas, two diameter method was more sufficient for evaluating the sensitivity than volume method. Macroscopically, the rate of remained implants was 88.2% and yielded an evaluable assay rate of 94.9%. As to sensitivity, the effective rate of CDDP was 24.3%, BLM was 5.9%, MTX was 8.6% and VDS was 20.7%. Histologically, the rate of tumor cells occupied in implant was decreased by grade of augmentation of effectiveness. Clinically, correspondence between the assay results and clinical result was obtained in 92.3%. SRCA is a new promising chemosensitivity test which is clinically useful, and the present results indicated the feasibility of its use in developing an effective chemotherapy for primary esophageal cancer.     

中晚期乳腺癌的血供特点及术前DSA造影下超选择性动脉插管灌注化疗栓塞的临床分析

目的 总结中晚期乳腺癌的血液供应来源和特点以及探索术前DSA造影下超选择性动脉插管灌注化疗栓塞的方法、疗效及临床应用价值.方法 选取我院2007年2月至2011年10月期间经穿刺活检病理证实的中晚期乳腺癌患者共60例,采用Seldinger方法,经股动脉穿刺插管后在DSA造影下明确肿瘤供血动脉分布,然后分别超选择性插管于靶血管内,将吡柔比星60 mg+紫杉醇120 mg二联化疗药物缓慢注入靶血管内,实施介入灌注化疗,最后使用明胶海绵颗粒栓塞肿瘤供血动脉.结果 60例患者经DSA造影共发现112条明确的供血动脉,其中单支供血8例;多支供血52例,主要以胸外侧动脉和(或)胸廓内动脉供血为主.完全缓解率为25.0％(15/60),部分缓解率为73.3％ (44/60),稳定率为1.7％ (1/60),无进展病例,总有效率为98.3％ (59/60).中位缓解期19个月,中位生存期40个月.结论 乳腺癌原发肿瘤的位置与供血动脉密切相关,肿瘤位于乳腺外侧主要由胸外侧动脉主导供血,肿瘤位于乳腺内侧主要由胸廓内动脉主导供血.乳腺癌术前DSA造影下超选择性供血动脉插管、靶血管区域实施灌注化疗和明胶海绵颗粒栓塞,可明显提高乳腺癌新辅助化疗的疗效、远期生存率及介入化疗栓塞治疗的针对性.     

ATP—TCA技术指导浅表性膀胱癌术后灌注化疗的临床应用

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。     

In vitro sensitivity testing of human kidney tumors to cytostatic drugs with a rapid in vitro test

We present a new modified in vitro culture assay for primary human renal cell carcinoma similar to the 'soft agar clonogenic assay'. However, the carrying out and expense of metrology are more simplified, allowing tumor-specific chemotherapeutic drug sensitivity testing under easier conditions. Twelve different samples of human renal carcinoma and one sample of a transitional cell carcinoma of the renal pelvis were tested for in vitro chemotherapy sensitivity using this modified colony-forming assay. The rate of tumor cells establishing in culture was 100%. Corresponding to clinical experience we observed a nearly complete resistance to the cytotoxic effects of standard chemotherapeutic agents at usual plasma concentrations in man. Only higher concentrated chemotherapeutic drugs showed in vitro therapeutic effects. The assay described here lasts about 7 days, which is beneficial from the clinical point of view. The modification of this in vitro chemotherapeutic drug treatment is unlimited for plasma concentration and duration of standard and experimental chemotherapeutic agents, drug combination and so on. So we have interesting scientific steps which could not have been undertaken under usual clinical-empirical conditions.     

The prognostic value of adjuvant and neoadjuvant chemotherapy in total cystectomy for locally advanced bladder cancer

PURPOSE: Adjuvant chemotherapy and neoadjuvant chemotherapy have been widely used as adjuvant treatment in patients requiring total cystectomy for locally advanced transitional cell carcinoma of the bladder. However, there has been no conclusive evidence that the adjunctive chemotherapy improves survival and no agreement exists concerning what subsets of such patients receive significant benefits from the adjunctive chemotherapy. The study retrospectively sought to clarify these points. PATIENTS AND METHODS: We retrospectively analyzed clinical and pathological records of the 229 patients with transitional cell carcinoma of the bladder who underwent total cystectomy with or without lymph node dissection in our University Hospital from January 1975 to December 1997. Forty-two patients received 1-4 cycles (mean = 1.7) of adjuvant chemotherapy with VPMisCF (n = 19), CisCA (n = 4), MVAC (n = 8), or MEC (Methotrexate, Epirubicin and Cisplatin) (n = 11). Twenty-three patients received 1-4 cycles (mean = 2.1) of neoadjuvant chemotherapy with CisCA (n = 2), MVAC (n = 5), or MEC (n = 16). Using the Kaplan-Meier method, disease-specific survival rate was assessed according to various clinical and pathological factors as well as the administration of adjuvant or neoadjuvant chemotherapy. The generalized-Wilcoxon test was used to evaluate statistical significance (p < 0.05) of survival curves for two or more groups. In addition, a multivariate analysis using the Cox proportional hazards model was performed with respect to multiple clinical and pathological parameters, and treatment modalities. RESULTS: In patients who received neither adjuvant chemotherapy nor radiotherapy, the disease-specific survival rate was significantly lower in those with pT3a and/or more advanced tumors compared with those with pT2 or less advanced tumors. The survival rate in patients with positive lymph node metastasis was significantly lower than that in patients without lymph node metastasis. No apparent survival benefit was noted for those patients who received adjuvant chemotherapy when compared with patients who had pT3a or more advanced tumor and were followed without any adjunctive therapy. In patients with pN2 or more advanced lymph node metastasis, the survival rate of those who received adjuvant CisCA/MVAC/MEC chemotherapy was significantly higher than that those without any adjunctive therapy. Although no apparent survival benefit was observed in patients who received neoadjuvant chemotherapy, the survival rate in patients whose tumor was considered to be down-staged to pT1 or lower was significantly higher than patients who did not receive neoadjuvant chemotherapy and had pT3a or higher pT-stage tumor. The survival rate in patients whose tumor showed clinical partial or complete response by neoadjuvant chemotherapy was also significantly higher than the same control patients. However, the multivariate analysis revealed no significant survival benefit after adjuvant chemotherapy or after neoadjuvant chemotherapy. CONCLUSIONS: Adjuvant chemotherapy after total cystectomy is an acceptable approach in patients with pN2 or higher pN-stage bladder cancer. The significant survival benefit may be obtained who acquired pathological downstaging or partial to complete clinical response after neoadjuvant chemotherapy. To get maximum survival benefit from the present chemotherapeutic regimens and exclude administration of toxic chemotherapeutic agents to unresponsive patients, there should be more reliable markers that give clear information to differentiate tumors that will respond fairly to present chemotherapeutic regimens from tumors that will respond poorly.     

大肠癌细胞和外周血淋巴细胞对化疗药物的体外敏感性

目的:探讨大肠癌细胞及外周血淋巴细胞对化疗药物体外敏感性的及二者的相关性。方法:用MTT法检测40份大肠癌标本及外周血淋巴细胞对氟尿嘧啶(5-FU)、奥沙利铂(L-OHP)、伊立替康(CPT)单药、两药及三药(全量或半量)应用的敏感性。结果:单药最有效的药物依次为伊立替康、奥沙利铂和氟尿嘧啶,敏感率分别为35.0%、27.5%和20.0%;三药联合应用的抑制效果显著优于两药联合(P<0.05),三药全量及半量联合应用效果差异无显著性(P>0.05);癌细胞及外周血淋巴细胞对3种化疗药物的敏感性有很好的相关性(r=0.969)。结论:MTT可用于为大肠癌患者选择合适的化疗药物,由氟尿嘧啶、奥沙利铂及伊立替康的联合应用具有高效协同抑制大肠癌细胞的作用。     

Determinants of prognosis in breast cancer patients with tumor involvement of the skin (pT4b)

Determinants of prognosis were studied in patients with breast cancer with histologically proven tumor extension to the skin without clinical evidence of distant metastases (i.e., pT4b N0-3 M0). Data were collected retrospectively on 77 consecutive patients diagnosed in one community teaching hospital over the period from 1980 to 1995. The prognostic factor of tumor size showed a 5-year survival rate for patients with a tumor 相似文献