| ObjectiveThe sensitivity of esophageal cancer cells to five chemotherapy regimens(tegio+platinum,paclitaxel+platinum,5-fluorouracil+platinum,gemcitabine+platinum and docetaxel+platinum)was detected by using CD-DST.The difference of sensitivity of esophageal cancer patients to different chemotherapy regimens was analyzed,and the clinical medication of esophageal cancer patients after radical operation was guided according to the test results To investigate the guiding effect and clinical feasibility of this technique in the selection of chemotherapy scheme for patients with esophageal cancer after radical operation.MethodThe first part: a retrospective analysis of 60 patients with chemosensitivity detected by CD-DST after radical resection of esophageal cancer from September 2015 to January 2018 in the thoracic surgery of the northern theater general hospital was conducted to compare the sensitivity of esophageal cancer cells to different chemotherapy schemes.The second part: to further explore the guiding role and clinical feasibility of CD-DST detection in chemotherapy for patients with esophageal cancer after radical operation.Retrospective analysis of esophageal cancer patients admitted to thoracic surgery of northern theater general hospital from September 2015 to January2018,all underwent radical resection.According to the inclusion and exclusion criteria,a total of 56 patients with esophageal cancer after radical operation were included,28 of whom had completed CD-DST test after operation,and guided postoperative adjuvant chemotherapy according to the test results.The other 28 patients were not detected by CD-DST,and were set as the control group.The 1-year and 2-year survival rates of CD-DST group and control group were compared.The CD-DST group was divided into sensitive group and resistant group,and the survival rates of sensitive group and control group were compared.According to the lymph node metastasis,the CD-DST group and the control group were further divided into: lymph node positive CD-DST group and lymph node positive control group,lymph node negative CD-DST group and lymphnode negative control group.The survival rates of 1 and 2 years after operation were compared.ResultOf the 60 patients received CD-DST,24(40.0%)were sensitive to only one chemotherapy regimen,5(8.3%)to two chemotherapy regimens,10(16.7%)to three chemotherapy regimens,6(10.0%)to four chemotherapy regimens,and 1(1.6%)to five chemotherapy regimens.14 cases were not sensitive to all chemotherapy regimens,and the complete drug resistance rate was 23.3%.The sensitivity rates of the five chemotherapy regimens were 43.3%(26/60)of gemcitabine+platinum,36.6%(22/60)of tegio+platinum,28.3%(17/60)of 5-fluorouracil+platinum,26.6%(16/60)of docetaxel+platinum,20.0%(12/60)of paclitaxel+platinum.The results showed that the sensitivity of patients to five chemotherapy regimens was statistically significant(P=0.029).LSD-t test was used to compare the differences between the two groups.The results showed that the differences between gemcitabine+platinum group and docetaxel+platinum group,gemcitabine+platinum group and paclitaxel+platinum group were statistically significant(P=0.009,P=0.003).The differences between the other groups were not statistically significant(P > 0.05).There was no significant difference between CD-DST group and control group in baseline data such as age,gender,tumor location,TNM stage,pathological type,differentiation degree(P > 0.05).The 1-year and 2-year survival rates of CD-DST group were 96.4%(27/28)and 85.7%(24/28),respectively,and those of control group were82.1%(23/28)and 57.1%(16/28),respectively.The 1-year survival rate of CD-DST group(96.4%)was higher than that of the control group(82.1%),the difference was not statistically significant(P=0.160),the 2-year survival rate of CD-DST group(85.7%)was higher than that of the control group(57.1%),the difference was not statistically significant(P=0.086).According to the results of CD-DST,the CD-DST group was divided into two groups: sensitive group(22 cases)and fully resistant group(6 cases).The difference of 1-year survival rate and 2-year survival rate between sensitive group and control group was compared.The results showed that the 1-year and 2-year survivalrates were 100%(22/22)and 85.7%(24/28)in the sensitive group,and 86.4%(19/22)and 57.1%(16/28)in the control group,respectively.There was no significant difference between the two groups(P=0.065).The two-year survival rate of CD-DST group was significantly higher than that of the control group(P=0.025).There was no significant difference in 1-year and 2-year survival rates between CD-DST group and control group(100% vs.83.3%,P=0.362,93.3% vs.73.3%,P=0.535).There was no significant difference in 1-year survival rate between CD-DST group and control group(93.7 vs.76.9%,P=0.191).The difference of 2-year survival rate was statistically significant(75 vs.30.8%,P=0.017).Conclusion1.Among the five chemotherapy regimens used for CD-DST detection,esophageal cancer cells are more sensitive to gemcitabine plus platinum than the other four regimens,especially when compared with taxol plus platinum and docetaxel plus platinum.2.According to the results of CD-DST,patients who choose sensitive chemotherapy have better survival benefits than those who choose empirically chemotherapy.3.According to the results of CD-DST,the sensitive chemotherapy has better survival benefit for the lymph node positive patients. |
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