| 摘要: |
| 目的 观察循环肿瘤细胞（CTC）药物敏感性指导的化学治疗在晚期胆系肿瘤中的临床疗效和安全性。方法 收集2018年7月至2020年4月海军军医大学（第二军医大学）东方肝胆外科医院肿瘤生物治疗科收治的26例晚期胆系肿瘤患者，抽取患者外周血分离和富集CTC，用胆系肿瘤中常用的固定化学治疗方案进行药物敏感性检测，选取最佳方案对患者进行化学治疗（CTC组）。选择同期19例行GEMOX方案（吉西他滨+奥沙利铂）化学治疗的晚期胆系肿瘤患者作为对照（GEMOX组）。观察两组患者化学治疗后的客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）、总生存期（OS）及安全性。结果 所有患者均可评价疗效与安全性，CTC组完全缓解1例，部分缓解4例，疾病稳定12例，疾病进展9例；GEMOX组部分缓解1例，疾病稳定10例，疾病进展8例。CTC组和GEMOX组患者的ORR分别为19.2%（5/26）和5.3%（1/19），DCR分别为65.4%（17/26）和57.9%（11/19）。CTC组患者的中位PFS为5.8个月（95% CI 4.5~7.2个月），GEMOX组为5.1个月（95% CI 4.6~6.4个月），差异无统计学意义（P=0.313）。CTC组患者的中位OS为13.6个月（95% CI 10.8~16.3个月），GEMOX组为7.9个月（95% CI 5.5~10.3个月），差异有统计学意义（P=0.003）。所有患者中，主要不良反应有贫血、中性粒细胞减少、血小板减少、乏力及厌食，均可耐受，且无治疗相关性死亡。结论 CTC药物敏感性指导的化学治疗提高了晚期胆系肿瘤反应率，延长了患者总生存期，且不良反应可耐受。CTC药物敏感性检测可操作性强，对临床准确选择个体化化学治疗方案有一定的指导价值，值得进一步推广。 |
| 关键词: 循环肿瘤细胞 抗肿瘤药物筛选试验 胆道肿瘤 化学治疗 |
| DOI：10.16781/j.0258-879x.2021.10.1098 |
| 投稿时间：2021-03-24修订日期：2021-08-24 |
| 基金项目: |
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| Circulating tumor cell drug sensitivity-guided chemotherapy for advanced biliary tract cancer: a clinical efficacy analysis |
| KOU Xiao-xia,GUO Ling-ling,QIU Jin-rong* |
(Department of Oncology Biotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University(Second Military Medical University), Shanghai 201805, China
*Corresponding author) |
| Abstract: |
| Objective To observe the clinical efficacy and safety of circulating tumor cell (CTC) drug sensitivity-guided chemotherapy in the treatment of advanced biliary tract cancer. Methods Twenty-six patients with advanced biliary tract cancer treated in the Department of Oncology Biotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University) from Jul. 2018 to Apr. 2020 were included. The CTCs were isolated and enriched from the peripheral blood. The drug sensitivity was tested with the fixed chemotherapy regimen commonly used in biliary tract cancer, and the best regimen was selected for chemotherapy (CTC group). Nineteen patients with advanced biliary tract cancer treated with GEMOX regimen (gemcitabine+oxaliplatin) during the same period were selected as the controls (GEMOX group). The objective response rate (ORR), disease control rate (DCR), progress-free survival (PFS), overall survival (OS) and safety of the 2 groups were observed. Results The efficacy and safety were evaluated in all the patients: 1 case achieved complete remission (CR), 4 cases achieved partial remission (PR), 12 cases had stable disease (SD) and 9 cases had progressive disease (PD) in the CTC group; and 1 case reached PR, 10 cases had SD and 8 cases had PD in the GEMOX group. The ORRs of the CTC group and GEMOX group were 19.2% (5/26) and 5.3% (1/19), and the DCRs were 65.4% (17/26) and 57.9% (11/19), respectively. The median PFS was 5.8 months (95% confidence interval[CI] 4.5-7.2 months) in the CTC group and 5.1 months (95% CI 4.6-6.4 months) in the GEMOX group, showing no significant difference (P=0.313). The median OS was 13.6 months (95% CI 10.8-16.3 months) in the CTC group and 7.9 months (95% CI 5.5-10.3 months) in the GEMOX group, showing significant difference (P=0.003). In all patients, the main adverse events were anemia, neutropenia, thrombocytopenia, fatigue and anorexia, all of which were tolerable, and there was no treatment-related death. Conclusion CTC drug sensitivity-guided chemotherapy improves the tumor response rate of advanced biliary cancers, prolongs the overall survival of the patients, and the adverse events are tolerable. CTC drug sensitivity test is convenient, and is valuable for accurate clinical selection of individualized chemotherapy regimens, so it is worthy of further promotion. |
| Key words: circulating neoplastic cells antitumor drug screening assays biliary tract neoplasms chemotherapy |
