化疗药物敏感试验在肝细胞癌患者化疗中的应用

目的采用四甲基偶氮唑盐（MTT）法检测不同化疗药物对肝细胞癌（HCC）的敏感性来指导肝动脉和门静脉区域化疗的个体化化疗方案。方法选取我院2008年12月至2011年12月收治的不能手术切除的42例HCC患者肝癌样本,采用原代肝癌细胞培养联合MTT法检测5-氟尿嘧啶、顺铂、丝裂霉素、阿霉素、羟基喜树碱、吉西他滨、奥沙利铂7种常用化疗药物的敏感性,并根据药敏实验选择个体化化疗方案,指导其中24例患者接受肝动脉和门静脉区域化疗,与传统肝动脉灌注化疗（TAI）治疗的20例患者对比观察疗效。敏感率的比较采用卡方检验,至疾病进展时间（TTP）的比较采用秩和检验。结果肝癌对药物敏感率依次为奥沙利铂64.3%、羟基喜树碱45.2%、顺铂40.5%、吉西他滨38.1%、阿霉素33.3%、5-氟尿嘧啶21.4%、丝裂霉素16.7%。根据药敏实验选择个体化化疗方案的药敏组出现治疗敏感的符合率为70.8%,并与对照组相比在客观缓解率（50.0%vs 20.0%,P=0.039）、疾病控制率（70.8%vs 35.0%,P=0.017）及TTP[（4.7±2.9）m vs（2.6±1.3）m,P=0.032]方面有明显优势。结论体外MTT法药敏实验可作为肝癌个体化化疗药物的筛选手段,用于指导肝癌肝动脉和门静脉区域化疗从而提高化疗疗效。

Application of chemosensitivity test in regional chemotherapy for hepatocellular carcinoma via hepatic artery and portal vein

Objective To evaluate the chemosensitivities of hepatocellular carcinoma（HCC） to different chemotherapy drugs by 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyl-2H tetrazolium bromide（MTT） assay and to provide guidance for individualized chemotherapy regimen in regional chemotherapy via the hepatic artery and portal vein.Methods Forty-two HCC samples were selected.Primary culture of HCC cells combined with MTT assay were used to evaluate the chemosensitivities of HCC to 5-fluorouracil（5-FU）,cisplatin（DDP）,mitomycin C（MMC）,adriamycin（ADM）,hydroxycamptothecine（HCPT）,gemcitabine（Gemzar）,and oxaliplatin（OXA）.Individualized chemotherapy regimens were developed according to the chemosensitivity test results to guide regional chemotherapy via the hepatic artery and portal vein in 24 of these patients（as an individualized chemotherapy group）.The therapeutic efficacy was compared with that of transcatheter arterial infusion performed in 20 patients（as a control group）.The chi-square test was used for comparison of sensitivity rate,and the rank-sum test was used for comparison of time to progression（TTP）.Results The sensitivity rates of HCC were 64.3% to OXA,45.2% to HCPT,40.5% to DDP,38.1% to Gemzar,33.3% to ADM,21.4% to 5-FU,and 16.7% to MMC.Compared with the control group,the individualized chemotherapy group had a significantly higher objective response rate（50.0% vs 20.0%,P= 0.039）,a significantly higher disease control rate（70.8% vs 35.0%,P = 0.017）,and a significantly longer TTP（（4.7±2.9）m vs（2.6±1.3）m,P = 0.032）.Conclusion In vitro chemosensitivity test based on MTT assay may be used to screen out the chemotherapy drugs in individualized chemotherapy for HCC and provide guidance for regional chemotherapy via the hepatic artery and portal vein,so as to improve the effect of chemotherapy.