Inoue Masayoshi, Maeda Hajime, Takeuchi Yukiyasu, Fukuhara Kenjiro, Shintani Yasushi, Funakoshi Yasunobu, Funaki Soichiro, Nojiri Takashi, Kusu Takashi, Kusumoto Hidenori, Kimura Toru, Okumura Meinoshin
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachidori-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan.
Surg Today. 2018 Apr;48(4):380-387. doi: 10.1007/s00595-017-1594-7. Epub 2017 Oct 9.
We conducted a prospective clinical study to individualize adjuvant chemotherapy after complete resection of non-small-cell lung cancer (NSCLC), based on the drug sensitivity test.
Patients with resectable c-stage IB-IIIA NSCLC were registered between 2005 and 2010. We performed the collagen gel droplet-embedded culture drug sensitivity test (CD-DST) on a fresh surgical specimen to assess in vitro chemosensitivity and evaluated the prognostic outcome after adjuvant chemotherapy with carboplatin/paclitaxel based on the CD-DST.
Among 92 registered patients, 87 were eligible for inclusion in the analysis. The success rate of CD-DST was 86% and chemosensitivity to carboplatin and/or paclitaxel was evident in 57 (76%) of the 75 patients. Adjuvant chemotherapy was completed in 22 (73%) of 30 patients. The 5-year overall survival rates were 71, 73, and 75% for all, CD-DST success, and chemosensitive patients, respectively. The 5-year disease-free survival and overall survival rates of the chemosensitive patients who completed adjuvant chemotherapy using carboplatin/paclitaxel were 68 and 82%, respectively. The 5-year disease-free survival and overall survival rates of the patients with stage II-IIIA chemosensitive NSCLC were 58 and 75%, respectively. Comparative analyses of the chemosensitive and non-chemosensitive/CD-DST failure groups showed no significant survival difference.
CD-DST can be used to evaluate chemosensitivity after lung cancer surgery; however, its clinical efficacy for assessing individualized treatment remains uncertain.
我们开展了一项前瞻性临床研究，旨在基于药物敏感性试验对非小细胞肺癌（NSCLC）完全切除术后的辅助化疗进行个体化。
2005年至2010年期间登记了可切除的c期IB-IIIA期NSCLC患者。我们对新鲜手术标本进行胶原凝胶滴包埋培养药物敏感性试验（CD-DST）以评估体外化学敏感性，并基于CD-DST评估卡铂/紫杉醇辅助化疗后的预后结果。
92例登记患者中，87例符合纳入分析条件。CD-DST成功率为86%，75例患者中有57例（76%）对卡铂和/或紫杉醇表现出化学敏感性。30例患者中有22例（73%）完成了辅助化疗。所有患者、CD-DST成功患者和化学敏感患者的5年总生存率分别为71%、73%和75%。使用卡铂/紫杉醇完成辅助化疗的化学敏感患者的5年无病生存率和总生存率分别为68%和82%。II-IIIA期化学敏感NSCLC患者的5年无病生存率和总生存率分别为58%和75%。化学敏感组与非化学敏感/CD-DST失败组的比较分析显示生存差异无统计学意义。
CD-DST可用于评估肺癌手术后的化学敏感性；然而，其在评估个体化治疗方面的临床疗效仍不确定。
