| Objective To investigate the significance of chemosensitivity in vitro guiding the choice of clinical individualized regimens,for non-small cell lung cancer(NSCLC)with malignant pleural effusion.Methods 30 cases of advanced NSCLC patients,were collected the malignant pleural effusion specimens,extracted tumor cells and prepared single cell suspension,as well as cultured the cells in vitro for proliferation.After this,all the specimens accepted the MTT assay in vitro,and all the patients accepted clinical chemotherapy according to the susceptibility testing results,in order to observe and evaluate the clinical efficacy of chemotherapy and the consistency between in vitro and in vivo.In the study,30 cases of advanced NSCLC patients who carried out the clinical chemotherapy under the guidance of drug sensitivity test,were defined as clinical chemotherapy susceptibility test group.We randomly collected the same period of another 30 cases of advanced NSCLC patients with malignant pleural effusion,who accepted clinical chemotherapy according to the current NCCN guidelines,and setted them to the control group.The susceptibility test group and the control group were underwent four cycles of chemotherapy,Comparedthe clinical efficacy between them.Followed up the patients of susceptibility test group and the control group for 2 years,The median progression-free survival(PFS)and median overall survival(OS)were compared.Results With the increase of drug concentration,tumor cells inhibition rate also increased.When drug concentration was 1.0P(PPC: peak plasma concentration),The inhibition rate of tumor cells in vitro of GP regimen is higher than other combined regimens(41.55%),P <0.05.Them of NP regimen,PP regimen,DP and TP regimen were close,for36.48%,34.56%,34.55%,33.91%.Among the 1.0P drug concentration of monotherapy in vitro,The tumor inhibition rate of gemcitabine was the highest,for30.98 percent,followed by cisplatin(25.90%)? pemetrexed(24.54%)? and docetaxel(24.48%),the difference was statistically significant(P <0.05).In addition,The two-drug combination chemotherapy was superior to single-agent chemotherapy in vitro.The study was also drawn:The difference between the susceptibility testing results in vitro and clinical efficacy of chemotherapy was statistically significant(P<0.05),The total coincidence rate of the results of chemosensitivity in vitro and therapeutic effectiveness was 80%,and Chemosensitivity in vitro predicted the rate of clinical resistance was 100%.Susceptibility testing sensitivity was 100% and specificity was 33.3%;positive predictive value was 77.8%,and negative predictive value was 100%.The susceptibility in vitro associated with therapeutic efficacy is good(P<0.05),and in vitro drug sensitivity rate(90% 27/30)was significantly higher than the rate of chemotherapeutic sensitivity(70%,21/30).After 4 cycles of clinical chemotherapy,the response rate and the disease control rate of the susceptibility test group(RR = 56.7%,DCR = 80.0%)were higher than the control group(RR = 30.0%,DCR = 66.7%),the difference of RR between the two groupswas statistically significant(P< 0.05),but the difference of DCR was not statistically significant(P > 0.05),the median PFS was statistically different(4.6 month: 3.5month,P <0.05).After followed up 2 years,the median OS of the susceptibility test group was 9.8 month,the control group was 7.2 month.The two groups had a statistically significant different(P <0.05).Conclusion MTT assay in vitro can effectively screen sensitive and resistant clinical chemotherapeutic drugs,and can improve the clinical efficacy and improve survival of patients.So it plays an important role in guiding individualized chemotherapy of non-small cell lung cancer. |
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