自体肿瘤细胞药敏检测指导膀胱癌术后灌注化疗个体化的研究

目的：探讨流式细胞计量肿瘤体外药敏检测技术研究膀胱癌药敏的异质性及指导术后灌注化疗个体化的可行性。方法：用肿瘤细胞原代培养方法和流式细胞计量术检测58例新鲜膀胱癌标本对7种常用灌注化疗药物的敏感性；药敏组58例患者，术后根据药敏结果，选用最敏感的化疗药物灌注，对照组60例患者，术后选用吡柔比星灌注，两组平均随访时间为18个月。结果：所有标本均获得药敏结果，可评价率为100％。不同个体对不同化疗药物的敏感性存在明显差异，单一某种药物N-不同个体膀胱癌细胞抑瘤率最低为0，最高为89．7％；不同化疗药物的敏感率分别为：羟基喜树碱22．4％，顺铂19．O％，阿霉素17．2％，5-氟尿嘧啶15．5％，表阿霉素12．1％，吡柔比星8．6％，丝裂霉素5．2％；膀胱癌病理分期、分级、复发性、多发性化疗药物敏感性差异均无统计学意义；药敏组无瘤率为79．3％，对照组无瘤率为56．7％，差异有统计学意义（P〈0．05）。结论：表浅性膀胱癌对灌注化疗药物的敏感性存在个体差异，流式细胞计量肿瘤体外药敏检测技术测定结果较好反映了该检测技术的异质性，提示其可指导膀胱癌术后灌注化疗药物个体化选择，实现治疗个体化，降低肿瘤复发率。

Individual Study on Guiding Postoperative Infusion Chemotherapy of Bladder Cancer by Drug Sensitivity Test of Autologous Tumor Cells

Objective ： To investigate the detection technique of measuring the tumor drug sensitivity in vitro of flow cytometry so as to study the heterogeneity of drug sensitivity of bladder cancer and guide the individual feasibility of the postoperative infusion chemotherapy. Methods：The primary cultured tumor cells and flow cytometry were used to deterct the specimens of 58 fresh bladder cancer for the drug sensitivity of seven kinds of common infusion chemotherapeutic drugs. The 58 patients with bladder cancer in the drug sensitivity group were infused by the most sensitive chemotherapeutic drugs according to the chemosensitivity results after operation and the 60 patients in the control group were infused by Pirarubicin. The mean follow-up time of the two groups was 18 months. Results：All specimens had obtained drug sen- sitivity results and the evaluable rate was 100%. Different individuals had significant difference to the different kinds of chemotherapeutic drugs. The minimum tumor inhibitory rate of some single kind of drug was 0 and the maximum was 89.7%. The sensitive rates of different kinds of chemotherapeutic drugs were Hydroxycamptothecin （22.4%）, Cisplatin （ 19.0% ）, Adriamycin（ 17.2% ） ,5-Fluorocytidine （ 15.5% ）, Epirubicin （ 12.1% ）, Pirarubicin （8.6%）, Mitomycin（ 5.2% ） respectively. There was no statistical significance in the sensitivity of chemotherapeutic drugs between the pathological stage, the grade, the recurrence and the multiple occurrence of bladder cancer. The tumor free rate was 79.3% in drug sensitivity group and the tumor free rate was 56.7% in the control group. The difference between them was statistical significant （P 〈 0.05 ）. Conclusion：There is individual difference of the superficial bladder cancer for the sensitivity of the infusion chemotherapeutic drugs. The determination results of the detection technique of measuring tumor drug sensitivity in vitro of flow cytometry reflect the heterogeneity preferably and suggest that it could guide the in- dividual choice of postoperative infusion chemotherapeutic drugs of bladder cancer so as to realize the individual treatment and decrease the tumor recurrence rate.