【作者】 孙凌；

【导师】 巩平；

【作者基本信息】 石河子大学 ， 肿瘤学， 2009， 硕士

【摘要】 目的:该课题采用MTT法筛选出敏感的化疗药物用于肺癌、乳腺癌患者的临床治疗,并与传统经验化疗进行比较,以期提高癌症患者的疗效和生存率,避免不必要的毒副作用,为临床个体化化疗提供理论依据。方法:共收集40例恶性肿瘤患者,采用MTT法测定其外周血淋巴细胞(PBL)对8种临床常用化疗药的敏感性,筛选敏感药物进行“个体化”化疗,并取48例不作药敏试验行常规化疗的肺癌和乳腺癌患者作为对照组,然后分别对两组进行临床评效,比较两组之间的差异是否存在统计学意义。结果:1.肺癌患者PBL对8种化疗药物的敏感顺序依次为:顺铂、紫杉醇、吉西他滨、卡铂、长春瑞滨、环磷酰胺、氟尿嘧啶、阿霉素;乳腺癌患者PBL对8种化疗药物的敏感顺序依次为:环磷酰胺、阿霉素、氟尿嘧啶、紫杉醇、顺铂、卡铂、吉西他滨、长春瑞滨。2.试验组的临床有效率为87.1%,与对照组(55%)相比具有统计学意义(P=0.004)。3.肺癌组中,不同治疗阶段的患者,试验组的有效率与对照组相比有统计学差异(P<0.05);对于不同病理类型来说,试验组的有效率也是明显高于对照组(P<0.05)。乳腺癌组中,对于不同治疗阶段的患者,试验组与对照组相比并无统计学意义(P>0.05)。4.肺癌组中,试验组根据药敏结果选择的药物联合方案,临床有效率明显高于对照组(P<0.05);乳腺癌组中,虽然两组总的有效率无统计学差异(P>0.05),但是对照组主要选择常规组合方式,选择其他方案仅14%,有效率只有33.3%,而实验组选择其他方案达25%,有效率为80.0%,差异具有统计学意义(P<0.05)。5.试验组和对照组的6个月、1年生存率并无明显差别(P>0.05)。6.将对照组中评效为临床无效的患者全部列出,抽取其外周血标本进行MTT法药敏试验,结果发现:这些患者选择的化疗药物中几乎都包含了药敏试验显示的不敏感药物。结论:1.本文关于肺癌对临床8种常用化疗药物的敏感顺序与既往研究基本一致,但乳腺癌对8种化疗药物的敏感顺序与既往的研究有所差异,考虑为本试验采集的标本例数较少所致,仍需进一步扩大样本量,进行深入研究。2.根据药敏试验结果选用敏感的化疗药物,可以有效地提高临床有效率,与传统经验化疗之间具有显著性差异。与国内外其他学者的研究结论相符,再次验证了PBL可替代肿瘤细胞进行药敏试验的理论。3.体外药敏试验不仅可以指导临床医师选择敏感药物来提高化疗效果,而且可以帮助医师排除不敏感的药物,避免/减轻无效化疗或耐药性的发生。4.药敏试验组的化疗方案更灵活,治疗更有针对性,说明在体外药敏试验指导下实现了肿瘤化疗的个体化。更多还原

【Abstract】 Purpose: the subject using MTT method to select the sensitive drug to lung cancer and breast cancer patients, and compare to the conventional chemotherapy. We wish to explore the relevance of the two and its clinical significance, with a view to improve cancer efficacy and survival rate of patients to avoid unnecessary side effects, and provide a theoretical basis for clinical chemotherapy individual. Methods: select 40 cases with malignant tumors, using MTT method to measured PBL’s sensitivity to eight kinds chemotherapy drugs, then choose the sensitive drug to "individuation" of chemotherapy. In another, select 48 cases of lung cancer and breast cancer patients as a control group, which does not take drug sensitivity test, but use the conventional chemotherapy. Finally, evalute the effect of the two group, whether there is statistically significance compared between the two groups.Results:1. The chemosensitivity order for lung cancer, which is DDP, taxinol, Gemcitabine, carboplatin, vinorelbine, Cytoxan, fluorouracil, ADM; The chemosensitivity order for mammary cancer, which is Cytoxan, ADM, fluorouracil, taxinol, DDP, carboplatin, Gemcitabine, vinorelbine.2. The therapeutic effects of the test group is 87.1%,there is statistical significance compared with the control group(55%)( P=0.004).3. In the lung cancer group, there is significant difference between the two groups with different stages of treatment (P <0.05); for the different pathological types, the test group is also significantly higher efficiency than the control group (P <0.05). In the breast cancer group, we don’t find the statistical significance between the two groups (P>0.05).4. In the lung cancer group, select the joint programs according to drug sensitivity results, the clinical efficiency has increased significantly (P<0.05); in the breast cancer group, there is no significant difference between the two group (P>0.05), but in the test group, there is 25% choose other ways of drug selection compare to the control group, and the clinical efficiency has the statistical significance between the two groups.5.There is no obvious difference (P<0.05) between the two group about half an year and 1-year survival rate. We think it result for taking as a fewer example and shorter follow-up, so we should expand the sample size and increase a longer period of comparative study of survival.6. Choose all the patients whose clinical efficiency was 0(except the death of patients), for 21 cases, taken their peripheral blood samples, and use the MTT method to measure drug sensitivity, results were as follows: almost the patients choose the drug which sensitivity test showed that non-sensitive drugs.Conclusion:1. In this paper, the research about sensitive sequence of lung cancer to 8 kinds of commonly used clinical chemotherapy drugs basically consistent with previous research. But sensitive sequence of breast cancer was different from previous studies. We think that fewer sample and shorter study due to it. We should to expand the sample size and take a further, in-depth study. 2. Select the chemotherapeutic drugs according to sensitivity tests result, can significantly improve clinical efficiency. Compare to the traditional chemotherapy, there is significantly different. The conclusions of the study in accordance with other scholars at home and abroad, once again verify the theory that PBL can be an alternative for tumor cells to take sensitivity test.3. Drug sensitivity test in vitro not only can guide clinicians to select drugs to enhance chemotherapy effect, but also can help doctors rule out non-sensitive drugs, to avoid/reduce the ineffective chemotherapy or the occurrence of drug resistance.4. We found the joint programs of drug selection in test group were more flexible, and had more targeted treatment. It illustrate that we achieve the individual chemotherapy under the guidance of the drug sensitivity test in vitro.更多还原