Kansarka naasaha & daaweynta kiimikada
Among the many cancers, breast cancer is probably the most difficult to decide whether to undergo chemotherapy after surgery. Similar to other cancers, the factors that determine breast cancer chemotherapy are (age, tumor size, metastasis of lymph nodes and other organs (so-called TNM, staging), ER, PR, CerbB-2, Ki-67, P53, etc.). If the results of the analysis are obviously sideways, it is easier to make a decision about whether to administer chemotherapy. But in many cases, the result of the analysis is exactly in the middle “gray zone” (I don’t exaggerate, there are many examples of middle zone), which will cause the situation of uncertainty. We often say: Second opinion (listen to the opinions of several doctors), but have you ever thought about it, even if you ask 10 doctors, the answer you get is likely to be: 5 say chemotherapy, 5 say no ( Still two opinions), isn’t it annoying.
Ka dib markaad haysato kansarka naasaha, it’s important to make a decision about whether to get chemotherapy. If patients who do not need chemotherapy receive unnecessary chemotherapy, it will not only waste time and money, but also endure the various side effects of chemotherapy (nausea, vomiting, hair loss, bone marrow suppression, infection, bleeding, etc.). Patients who originally needed chemotherapy miss the chance of chemotherapy, which increases the risk of recurrence.
Maxaa la sameeyaa?
Hal tijaabo ayaa waxaa kula taliyay American ASCO (American Clinical Oncology Association). Waxaa loo yaqaan 'oncotype DX'. Tijaabadani waxay isticmaashaa hab fudud oo bayooloji ah si ay u falanqeyso arrimaha kor ku xusan ee qaybta cudurada kansarka naasaha bukaanka, ka dibna waxay siisaa “Dhibic soo noqnoqota” (RS). Bukaanka qaba RS sare waxay ubaahan yihiin daaweynta kemotherabi, kuwa qaba RS hoose uma baahna kemotherabi. RS dhexda waxay ubaahantahay falanqeyn dheeri ah (in kastoo bukaanada badankood ee RS ee aaga dhexe aysan waxbadan kafaa'idin daaweynta kemotherabi).
Dalka Mareykanka, baaritaankaan wuxuu aad ugu badan yahay daaweynta kansarka naasaha, maxaa yeelay go'aanka ah in loo baahan yahay daaweynta kiimikada waxay si toos ah ula xiriirtaa saameynta daaweyntaada. Waxaa lagu qiyaasay in 225,000 kiisaska cusub ee kansarka naasaha ay sanad walba ka dhacaan Mareykanka, 94,500na waa kuwa qaata estrogen-ka oo wanaagsan waxaana loo tixgeliyaa inay yihiin musharixiinta daaweynta kiimikada. Qiimaha daaweynta kemotherabi ee bukaankiiba waa qiyaastii $ 15,000, iyo qiimaha hal tijaabo oo ah DX waa $ 4,000. Sidaa darteed, haddii dhammaan bukaanada leh dhibcaha khatarta yar aysan helin kiimoteraabiga, Mareykanku wuxuu keydin doonaa 300 milyan sanadkii $ 30.8 milyan.
Dr. Yuusuf Ragaz of the University of British Columbia in Vancouver and colleagues analyzed buro samples from 196,967 estrogen receptor-positive breast cancer patients from the database of Genomic Health, the parent company that developed the test, and found that oncotype DX The proportion of patients with positive axillary lymph nodes (59%) with a 10-year recurrence risk score below 18 was greater than that of patients with negative lymph nodes (54%).
These data indicate that oncotype DX testing should be performed on all estrogen receptor-positive breast cancer patients, ethically and economically, regardless of their axillary lymph node status. However, this test can only be applied for testing in hospitals in the United States, Japan and other regions. For details, please visit the Global Oncologist Network.
NCCN waxay ku talineysaa baaritaanka hidda-socodka kansarka naasaha: ncotype DX
Shirka 20aad ee Shabakadda Ka Hortagga Kansarka (NCCN) ee Sannadlaha ah waxaa lagu qabtay Maarso 12 ilaa 14, 2015 magaalada Hollywood, Florida, USA. Sida laga soo xigtay warka lagu sii daayay kulanka, NCCN waxay kaliya saxiixday baaritaanka genome ee kansarka naasaha goor hore. Yimaitong ayaa sheegay tan.
Amy Cyr oo ka tirsan Xarunta Kansarka ee Siteman ee Jaamacadda Washington, oo ka hadlaysa shirka, ayaa sheegtay in Oncotype DX, oo ay soo saartay Genomic Health, ay ku guuleysatay sharafkan.
Tijaabadani waxay leedahay laba hawlood. Marka lagu daro bixinta macluumaadka saadaalinta, tijaabada sidoo kale waxay leedahay saameyn saadaalin ah oo ku saabsan natiijooyinka daaweynta; waxay dhab ahaan saadaalin kartaa jawaabta bukaanka ee daaweynta kemotherabi.
Marka la soo koobo, Oncotype DX waa laba qalab oo loogu talagalay saadaalinta iyo saadaalinta.
Amy Cyr wuxuu yiri awoodiisa saadaalinta jawaab celinta daawada waxay ahayd "wax kadhigay mid muuqda ilaa hada." Waxay intaas ku dartay in tijaabooyinka kale ee molecular ee kansarka naasaha, oo ay ku jiraan MammaPrint, Prosigna, EndoPredict, iyo Cancer Index, aysan muujin caddayn labada awoodoodba.
o ncotype DX wuxuu ku habboon yahay hoormoonka qaata haweenka postmenopausal ee qaba kansarka naasaha (sidoo kale ku habboon HER2 negative, pT1, PT2, ama pT3 iyo pN0 ama pN1).
Dr Cyr wuxuu sheegay in suuqa tijaabada uu sii fidayo maadaama dumar badan laga helay kansarka naasaha goor hore, taas oo tilmaan u ah wax soo saarka, baaritaanka naasaha.
Dr. Cyr wuxuu sheegay in muujinta muuqaalka molikaliska uu yahay "mid ka mid ah guulaha ugu xiisaha badan" ee cilmiga caafimaadka, iyo baaritaano badan oo lagu sameeyay kansarka naasaha ayaa keenay xog dheeri ah.
"Tijaabada Oncotype DX waa aalad aad u faa'iido badan," ayuu yiri Michael Stone oo ka tirsan rugta caafimaadka ee Glealey ee Jaamacadda Colorado shirkii, kaas oo saadaalinaya halista soo noqnoqoshada maxalliga ama metastatic. Qaar badan oo ka mid ah bukaankayga waxay ku faraxsan yihiin inaysan u baahnayn daaweyn kiimiko ah. ”
Dr. Stone wuxuu sharraxay in daaweynta kiimikada guud ahaan aan lagula talin bukaanada leh dhibco soo noqnoqosho yar, laakiin waxaa lagula talinayaa bukaanada leh dhibco soo noqnoqod leh. Si kastaba ha noqotee, dhibcaha soo noqoshada waa aag cawlan. Waxa uu sheegay inuu ku talinayo kimikal daweynta ku saleysan ugu horreyn da'da bukaanka iyo caafimaadkiisa. Chemotherapy guud ahaan waxaa lagula talinayaa da 'yarta, bukaanka dhalmada kadib ee caafimaad qabka leh dhibcaha soo noqoshada dhexdhexaadka ah. Dr Cyr ayaa qirtay inay adag tahay in la ogaado in haweenka leh dhibcaha soo noqoshada ee dhexdhexaadka ah ay tahay inay qaataan daaweynta kiimikada.
Cyr wuxuu carabka ku adkeeyay in kastoo cudurka Onxotype DX uu kaliya ku haboon yahay bukaanka lymph node negative, hadana wuxuu sidoo kale umuuqdaa mid faa iido u leh bukaanada wanaagsan ee lymph node.
Waxay xustay daraasadda 'TransATAC', oo lagu bartilmaameedsaday haweenka qaba kansarka naasaha kadib ee lagu daweeyo anastrozole ama tamoxifen (J Clin Oncol. 2010; 28: 1829-1834). Oncotype DX waxaa loo isticmaalay in lagu falanqeeyo unugyada burooyinka bukaanka, iyo soo noqoshada qanjirada 'limfode node' iyo 'lymph node positive' ayaa loo xisaabiyay siday u kala horreeyaan.
Dr. Cyr wuxuu yiri "dhibcaha soo noqoshada waxaa loo isticmaali karaa saadaalin natiijada muddada-dheer ee labada koox ee bukaanada." Waxaa xusid mudan inay leedahay isla qiime saadaal ah bukaanada qaba 3 ama in kayar oo qanjidhada qanjidhada ah iyo 4 ama in ka badan oo qanjiro qanjidhada ah.
