Tumour chemotherapy sensitivity test may predict clinical outcomes in colorectal cancer patients receiving oxaliplatin and fluoropyrimidine-based regimens

doi:10.4251/wjgo.v17.i11.111171

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World Journal of Gastrointestinal Oncology

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1948-5204

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World J Gastrointest Oncol. Nov 15, 2025; 17(11): 111171
Published online Nov 15, 2025. doi: 10.4251/wjgo.v17.i11.111171

Tumour chemotherapy sensitivity test may predict clinical outcomes in colorectal cancer patients receiving oxaliplatin and fluoropyrimidine-based regimens

Si-Jia Li, Yi-Xuan Lu, Fang-Yue Zheng, Yi-Cong Bian, Li-Yan Miao, Chen-Rong Huang

Si-Jia Li, Yi-Cong Bian, Li-Yan Miao, Chen-Rong Huang, Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China

Yi-Xuan Lu, College of Pharmaceutical Science, Xuzhou Medical University, Xuzhou 221004, Jiangsu Province, China

Fang-Yue Zheng, Li-Yan Miao, Chen-Rong Huang, College of Pharmaceutical Science, Soochow University, Suzhou 215000, Jiangsu Province, China

Li-Yan Miao, Chen-Rong Huang, Institute for Interdisciplinary Drug Research and Translational Sciences, Soochow University, Suzhou 215006, Jiangsu Province, China

Co-corresponding authors: Li-Yan Miao and Chen-Rong Huang.

Author contributions: Li SJ, Miao LY, and Huang CR designed the research study; Li SJ, Lu YX, Zheng FY, Bian YC, Miao LY, and Huang CR performed the research; Li SJ, Lu YX, and Zheng FY analyzed the data and wrote the manuscript. All authors have read and approve the final manuscript. Miao LY and Chen-Rong Huang contributed equally to this study and are co-corresponding authors.

Supported by the National Natural Science Foundation of China, No. U24A20765 and No. T2321005; Jiangsu Provincial Science and Technology Plan Special Fund, No. BM2023003; Jiangsu Provincial Medical Key Discipline, No. ZDXK202247; the Priority Academic Program Development of the Jiangsu Higher Education Institutes; Jiangsu Engineering Research Center on Drug Evaluation and Translation of Organoids/Organ Chip (2024); the Science and Technology Plan of Suzhou, No. SKYD2023183; the Research Project Established by Chinese Pharmaceutical Association Hospital Pharmacy Department, No. CPA-Z05-ZC-2023002; and Gusu Health Talent Research Project, No. GSWS2022015.

Institutional review board statement: Ethical approval for this study was obtained from the Research Ethics Board of the First Affiliated Hospital of Soochow University (No. 2023178).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Chen-Rong Huang, PhD, Department of Pharmacy, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. huangchenrong@suda.edu.cn

Received: June 25, 2025
Revised: August 27, 2025
Accepted: September 28, 2025
Published online: November 15, 2025
Processing time: 142 Days and 20.3 Hours

Abstract

BACKGROUND

Chemotherapy is an essential treatment for colorectal cancer (CRC) patients after surgery, but many patients do not benefit from chemotherapy because tumour heterogeneity results in varied responses.

AIM

To study the effectiveness of in vitro chemosensitivity tests adenosine triphosphate-based tumour chemotherapy sensitivity test (ATP-TCA) for tailoring postoperative chemotherapy regimens for patients with CRC.

METHODS

Between January 2015 to December 2021, a total of 1549 CRC patients underwent surgery and in vitro chemosensitivity testing using ATP-TCA. A subset of 405 patients who met the survival assessment criteria were followed to collect data on overall survival (OS) and disease-free survival (DFS). Cox regression analysis revealed independent prognostic factors that affect OS and DFS for those receiving oxaliplatin (L-OPH) and fluoropyrimidine-based regimens, aiding in the development of clinical predictive models. The relationships between the ATP-TCA results and clinical outcomes were analysed using the Kaplan-Meier method.

RESULTS

Tumour heterogeneity and resistance to multiple drugs were observed in 1549 patients. The sensitivity to 5-fluorouracil (5-FU) combined with L-OPH was tested among 1474 of these patients, yielding a sensitivity rate of 11.9%. ATP-TCA results were identified as an independent prognostic factor for DFS [P = 0.002, hazard ratio (95% confidence interval): 4.98 (1.81-13.72)] in patients with resectable CRC. Compared with drug-resistant patients, sensitive CRC patients treated with 5-FU and L-OPH had significantly prolonged DFS (P = 0.027). Further Kaplan-Meier analysis indicated that ATP-TCA sensitivity was significantly associated with improved OS (P = 0.048) and DFS (P = 0.003) in patients with stage III CRC.

CONCLUSION

The response of CRC patients to the combination regimen of 5-FU and L-OPH is heterogeneous. This study confirmed that the ATP-TCA is a valuable tool for predicting clinical outcomes, such as DFS, in patients with resectable CRC receiving chemotherapy. Although further validation with multicentre data is still necessary, these findings support that the ATP-TCA may function as a guiding tool for personalized chemotherapy administration, thereby optimizing treatment opportunities for patients.

Keywords: Colorectal cancer; Precision oncology; Adenosine triphosphate-based tumour chemotherapy sensitivity test; Clinical prediction model; Chemosensitivity; 5-fluorouracil; Oxaliplatin

Core Tip: In this study, retrospectively evaluated the clinical application of adenosine triphosphate-based tumour chemotherapy sensitivity test (ATP-TCA) and revealed that it is an independent prognostic factor for disease-free survival in patients with resectable colorectal cancer. Additionally, an ATP-TCA-sensitive chemotherapy regimen was shown to significantly improve overall survival and disease-free survival in colorectal patients in stage III. Although the necessity for further validation, this study provides evidence supporting the extension of ATP-TCA assays to combination chemotherapy regimens for colorectal cancer while providing a theoretical basis and perspective for future advancements in personalized medicine.