体外肿瘤药敏试验指导非小细胞肺癌个体化新辅助化疗的临床研究

目的探讨应用三磷酸腺苷生物荧光肿瘤化疗药敏检测（ATP-TCA）法指导非小细胞肺癌（NSCLC）个体化新辅助化疗的临床疗效。方法79例Ⅱ～Ⅲ期NSCLC患者，分为试验组40例，行ATP—TCA体外药敏检测，根据检测结果，选择敏感化疗方案行个体化新辅助化疗，体外无效者不行新辅助化疗；对照组39例选择常规第三代含（顺）铂两药联合化疗方案行新辅助化疗。结果试验组标本可评估率为92．5％，体外无效13．5％；四种化疗方案的体外有效率依次为吉西他滨＋顺铂81．1％，多西他赛＋顺铂（DP）78．4％，长春瑞滨＋顺铂（NP）62．2％及柴杉醇＋顺铂（TP）59．5％，各组比较差异无统计学意义。试验组临床有效率78．1％，手术完全切除率93．8％，对照组分别为64．1％和82．9％，差异无统计学意义。病理学疗效评价，试验组有效率78．1％，对照组54．3％，差异有统计学意义，与临床疗效评价不完全一致。结论根据ATP-TCA药敏检测结果指导NSCLC患者个体化新辅助化疗，结合病理组织学分级评价辅助化疗效果，有可能提高化疗疗效，减少无效化疗。

Application of adenosine triphosphate tumor chemosensitive assay system to individual neoadjuvant chemotherapy for non-small-cell lung cancer

Objective To study the application value ATP bioluminescence tumor chemosensitivity assay （ATP-TCA） directed individual neoadjuvant chemotherapy in patients with non-small cell lung cancer （NSCLC）. Methods The study included 79 patients with stage Ⅱ～Ⅲ NSCLC. We tested the specimens from 40 patients for chemosensitivity using ATP-TCA. 32 were given the most suitable regimen according to testing,and 39 were allocated to receive a standard regimen of platinum-containing doublet chemotherapy as controls. Results Available evaluation of specimen is 92.5%. Four platinum-containing combined chemotherapy regimens：GEN and DDP （GP） regimen, DOC and DDP（DP） regimen, NVB and DDP（NP） regimen,TAX and DDP（TP） regimen were carried out,and the in vitro effective rates of GP,DP,NP and TP were 81.1%, 78.4% ,62.2% and 59.5%, respectivdy. The response rate of neoadjuvant chemotherapy and the resection rate were 78.1% and 93.8% in test group ,64.1% and 82.9% in control group,respectively（ P 〉 0.05 ）. But the response rate evaluated by pathological evaluation was 78.1% for the test group, much better than the control groupg 54.3 % （ P 〈 0.05 ）. C, onchmions ATP-TCA might be useful in planning individualized neoadjurant chemotherapy regimen for NSCLC patient. Effect of neoadjuvant chemotherapy should be evaluated by the grading of pathological changes,