CAJ | 학술논문

目的评估草酸铂用于原发性肝癌术后化疗的疗效，同时联合体外药敏试验进行药物筛选，评估该系统是否可提高化疗疗效。方法26例原发性肝癌患者均在接受手术切除后肿瘤标本采用了体外药物敏感实验-三磷酸腺苷肿瘤化疗敏感实验(adenosine triphosphate tumor chemo-sensitivity assay，ATP-TCA)进行了药物(阿霉素、丝裂霉素、诺消灵、草酸铂、开普拓、5-FU、健择、卡铂、顺铂、泰索帝和足叶已甙)评估，其中草酸铂敏感11例(敏感组)，15例未报敏感(对照组)。全部患者接受了以草酸铂为主的化疗方案治疗。参照RECIST标准对该方案疗效(CR、PR、SD、PD、ORR、OS和DFS)以及ATP-TCA试验系统的效力进行评估，按照抗癌药毒副反应的分度标准(WHO标准)评价疗效及毒副反应。结果26例获得可评估客观疗效。该方案总疗效分析:CR 10例(38.46％)，PR 5例(12.23％)，SD 6例(23.08％)，PD 5例(12.23％)。在敏感组患者中，6例患者获得CR，3例PR，1例SD，1例PD;对照组4例获得CR，2例PR，5例SD，4例PD。两组比较差异无统计学意义(P＞0.05)，两组在总生存期(OS，P=0.1116)和无瘤生存期(DFS，P=0.2328)方面差异无统计学意义(P＞0.05)，而敏感组在总病情缓解率(ORR，81.8％vs40.0％，P=0.040)方面表现出明显的优势。共发生Ⅰ、Ⅱ度骨髓抑制14例(53.8％)，Ⅰ、Ⅱ度胃肠道反应13例(50％)，Ⅰ、Ⅱ度肝功能损害15例(57.7％)，Ⅰ、Ⅱ度周围神经病变6例(23.1％)。以上并发症多为Ⅰ - Ⅱ度，均可耐受，经过治疗后均恢复正常，两组毒副反应差异无统计学意义(P＞0.05)。结论以草酸铂为主的联合化疗方案在原发性肝癌术后化疗的疗效较高，此化疗方案可能提高肝癌术后患者的总病情缓解率，安全性好。联合应用ATP-TCA系统进行药物评估，可能提高该方案使用效率。
목적 평고초산박용우원발성간암술후화료적료효，동시연합체외약민시험진행약물사선，평고해계통시부가제고화료료효。방법26례원발성간암환자균재접수수술절제후종류표본채용료체외약물민감실험-삼린산선감종류화료민감실험(adenosine triphosphate tumor chemo-sensitivity assay，ATP-TCA)진행료약물(아매소、사렬매소、낙소령、초산박、개보탁、5-FU、건택、잡박、순박、태색제화족협이대)평고，기중초산박민감11례(민감조)，15례미보민감(대조조)。전부환자접수료이초산박위주적화료방안치료。삼조RECIST표준대해방안료효(CR、PR、SD、PD、ORR、OS화DFS)이급ATP-TCA시험계통적효력진행평고，안조항암약독부반응적분도표준(WHO표준)평개료효급독부반응。결과26례획득가평고객관료효。해방안총료효분석:CR 10례(38.46％)，PR 5례(12.23％)，SD 6례(23.08％)，PD 5례(12.23％)。재민감조환자중，6례환자획득CR，3례PR，1례SD，1례PD;대조조4례획득CR，2례PR，5례SD，4례PD。량조비교차이무통계학의의(P＞0.05)，량조재총생존기(OS，P=0.1116)화무류생존기(DFS，P=0.2328)방면차이무통계학의의(P＞0.05)，이민감조재총병정완해솔(ORR，81.8％vs40.0％，P=0.040)방면표현출명현적우세。공발생Ⅰ、Ⅱ도골수억제14례(53.8％)，Ⅰ、Ⅱ도위장도반응13례(50％)，Ⅰ、Ⅱ도간공능손해15례(57.7％)，Ⅰ、Ⅱ도주위신경병변6례(23.1％)。이상병발증다위Ⅰ - Ⅱ도，균가내수，경과치료후균회복정상，량조독부반응차이무통계학의의(P＞0.05)。결론이초산박위주적연합화료방안재원발성간암술후화료적료효교고，차화료방안가능제고간암술후환자적총병정완해솔，안전성호。연합응용ATP-TCA계통진행약물평고，가능제고해방안사용효솔。
Objective To investigate the effectiveness of combined oxaliplatin regimen as adjuvant chemotherapy for hepatocellular carcinoma and to evaluate the efficacy of using adenosine triphosphate tumor chemosensitivity assay (ATP-TCA) for direction of individual chemotherapy.Methods The twenty-six patients with primary hepatocellular carcinoma were operated.Specimens were collected and adenosine triphosphate tumor chemosensitivity assay (ATP-TCA) was applied to evaluate the sensitiveness of chemotherapy agent(Adriamycin, Mitomycin, Mitoxantrone, Oxaliplatin, Irinotecan, 5-FU, Gemzar, Carboplatin, Cisplatin, Docetaxel and Etoposide).Sensitive group (SG) was from from 11 patients who were sensitive to oxaliplatin, and control group was from the other 16 patients who were not sensitive to oxaliplatin.All the twenty-six patients received oxaliplatin combined with 5-FU or capecitabine regimen chemotherapy.The effectiveness (CR,PR,SD,PD,ORR,OS and DFS) of the regimen according to RECIST criteria and WHO criteria for anticancer drugs toxicity and efficacy of ATP-TCA were evaluated.Results Twenty-six patients were successfully evaluated.In SG, six patients obtained complete remission(CR), three got partial remission(PR), one got stable disease (SD) and one patient got progression disease (PD).While in control group,four patients obtained CR,two patients got PR, five patients got SD and four got PD.No significant differences were found in overall survival (OS, P = 0.1116) and disease-free survival (DFS, P = 0.2328)between sensitive group and control group.But significant differences were found in overall response rate (ORR) (81.8％ vs 40.0％, P =0.0401) between two groups.Common toxicities were as follows:I to Ⅱdegree of myelosuppression was 53.8％, I to Ⅱ degree of gastrointestinal tract response was 50％, I to Ⅱ degree of liver function damage was 57.7％ and I to Ⅱ degree of neuropathy was 23.1％, respectively.Most of these toxicities were tolerable at grade 1 ～ 2.No significant differences were found in the toxicities between two groups.Conclusions Combined oxaliplatin regimen might be an effective choice for adjuvant chemotherapy for HCC, which has with tolerable systemic toxicity.Application of ATP-TCA system might further improve the efficacy of this regimen by selecting right candidate.