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目的:O~6-甲基鸟嘌呤-DNA甲基转移酶(O~6-methylguanine-DNA methyltransferase,MCMT)是与恶性胶质瘤对替莫唑胺(temozolomide,TMZ)等烷化剂耐药相关的重要指标。本文总结根据MCMT表达状态选择不同的化疗方案,对复发恶性胶质瘤患者进行挽救性化疗的临床疗效。方法:经手术后病理确诊的复发恶性胶质瘤患者30例,均有可评价病灶应用免疫组化法检测肿瘤MGMT表达状态,分为阳性组和阴性组。阳性组患者应用非TMZ常规5天方案或非烷化剂药物进行化疗,阴性组患者不限制化疗方案。结果:全组患者客观有效率为20%,中位无进展生存时间为8个月(95%CI:4.3～11.7),中位生存时间为16个月(95%Cl:7.4～24.6) 其中MCMT阳性组16例,阴性组14例阳性组和阴性组患者的客观有效率分别为18.8%和21.4%,中位无进展生存时间分别为7个月(95%Cl:3.1～10.9)和8个月(95%CI:3.9～12.1),中位生存时间分别为16个月(95%CI:5.4～26.6)和16个月(95%CI:7.3～24.7),差异均无统计学意义(P>0.05)结论:复发恶性胶质瘤挽救性化疗具有良好的临床获益,根据肿瘤MGMT表达进行个体化化疗,特别是对于MGMT阳性复发恶性胶质瘤患者,能够避免耐药,得到与MGMT阴性患者相当的临床疗效
OBJECTIVE: O ~ 6-methylguanine-DNA methyltransferase (MCMT) is associated with resistance to alkylating agents such as temozolomide (TMZ) in malignant gliomas index. This article summarizes the selection of different chemotherapy regimens according to MCMT expression status, the clinical efficacy of salvage chemotherapy in patients with recurrent malignant glioma. Methods: Thirty patients with pathologically confirmed recurrent malignant gliomas were recruited. All lesions were evaluated for MGMT expression using immunohistochemistry, which was divided into positive group and negative group. Patients in the positive group were treated with non-TMZ conventional 5-day regimen or with non-alkylating agents for chemotherapy, and patients in the negative group were not limited to chemotherapy regimens. Results: The objective response rate was 20% in all patients, the median progression-free survival time was 8 months (95% CI: 4.3 to 11.7), and the median survival time was 16 months (95% CI 7.4 to 24.6) The objective response rates of 16 patients in MCMT positive group and 14 patients in negative group were 18.8% and 21.4% respectively, and the median progression-free survival time was 7 months (95% Cl: 3.1-10.9) and 8 Months (95% CI: 3.9-12.1). The median survival time was 16 months (95% CI: 5.4-26.6) and 16 months (95% CI: 7.3-24.7), respectively, with no significant difference (P> 0.05) .Conclusion: The salvage chemotherapy for recurrent glioblastoma has good clinical benefit. Individual chemotherapy is based on the expression of MGMT, especially in patients with MGMT-positive recurrent malignant glioma, MGMT-negative patients with considerable clinical efficacy