Umdlavuza webele kanye ne-chemotherapy
Phakathi kwemidlavuza eminingi, umdlavuza webele cishe yiwona onzima kakhulu ukunquma ukuthi uzokwelashwa ngamakhemikhali yini ngemva kokuhlinzwa. Ngokufanayo nezinye izinhlobo zomdlavuza, izici ezinquma ukwelashwa ngamakhemikhali omdlavuza webele yilezi (iminyaka yobudala, usayizi wesimila, i-metastasis yama-lymph nodes nezinye izitho zomzimba (okuthiwa yi-TNM, isiteji), i-ER, PR, CerbB-2, Ki-67, P53, njll. .). Uma imiphumela yokuhlaziywa ngokusobala isemaceleni, kulula ukwenza isinqumo mayelana nokuthi uzophathwa yini ngamakhemikhali. Kodwa ezimweni eziningi, umphumela wokuhlaziywa uphakathi "grey zone" ephakathi (angenzi ihaba, kunezibonelo eziningi zendawo ephakathi), okuzobangela isimo sokungaqiniseki. Sivame ukuthi: Umbono wesibili (lalela imibono yodokotela abaningana), kodwa uke wacabanga ngakho, noma ungabuza odokotela abayi-10, impendulo oyitholayo kungenzeka ukuthi: 5 ithi i-chemotherapy, i-5 ithi cha ( Namanje ababili imibono), akucunuli.
Ngemuva kokuba unayo umdlavuza webele, 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.
Okufanele ngikwenze ?
Ukuhlolwa okukodwa kunconywe yi-American ASCO (American Clinical Oncology Association). Ibizwa nge-oncotype DX. Lokhu kuhlola kusebenzisa indlela elula yebhayoloji yamangqamuzana ukuze kuhlaziywe izici ezibalwe ngenhla esigabeni se-pathological yesiguli somdlavuza webele, bese kunikeza “I-Recurrent Score” (RS). Iziguli ezine-RS ephezulu zidinga ukwelashwa ngamakhemikhali, kanti lezo ezine-RS ephansi azidingi ukwelashwa ngamakhemikhali. I-RS phakathi nendawo idinga ukuhlaziya okwengeziwe (nakuba iziguli eziningi ezine-RS endaweni emaphakathi zingazuzi kangako ekwelapheni ngamakhemikhali).
E-United States, lokhu kuhlolwa kuvame kakhulu ekwelashweni komdlavuza webele, ngoba isinqumo sokuthi udinga i-chemotherapy sihlobene ngqo nomphumela wakho wokwelashwa. Kulinganiselwa ukuthi izigameko zomdlavuza webele ezintsha ezingu-225,000 zenzeka unyaka ngamunye e-United States, futhi ezingu-94,500 zine-estrogen receptor positive futhi zibhekwa njengabazokwelashwa ngamakhemikhali. Izindleko zokwelashwa ngamakhemikhali ngesiguli ngasinye zilinganiselwa ku-$15,000, kanti izindleko zokuhlolwa kwe-oncotype DX eyodwa zingu-$4,000. Ngakho-ke, uma zonke iziguli ezinezibalo ezisengozini ephansi zingayitholi i-chemotherapy, i-US izokonga izigidi ezingama-300 ngonyaka amaRandi ayizigidi ezingama-30.8.
UDkt Joseph Ragaz of the University of British Columbia in Vancouver and colleagues analyzed isisu 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%).
Le datha ikhombisa ukuthi ukuhlolwa kwe-oncotype DX kufanele kwenziwe kuzo zonke iziguli ezinomdlavuza webele ezine-estrogen receptor-positive, ngokuziphatha nangokomnotho, kungakhathaliseki isimo sazo se-axillary lymph node. Kodwa-ke, lokhu kuhlolwa kungafakwa kuphela ekuhlolweni ezibhedlela zase-United States, Japan nakwezinye izifunda. Ukuze uthole imininingwane, sicela uvakashele i-Global Oncologist Network.
I-NCCN incoma ukuhlolwa kofuzo komdlavuza webele: ncotype DX
Ingqungquthela Yonyaka Ye-National Comprehensive Cancer Network (NCCN) yabanjwa kusukela ngo-March 20 kuya ku-12, 14 eHollywood, eFlorida, e-USA. Ngokusho kwezindaba ezikhishwe emhlanganweni, i-NCCN isayine kuphela ukuhlolwa kwe-genome yomdlavuza webele wakuqala. Yimaitong kubika lokhu.
U-Amy Cyr weSiteman Cancer Centre eNyuvesi yaseWashington, ekhuluma engqungqutheleni, uthe i-oncotype DX, eyakhiwe yi-Genomic Health, izuze le ndondo.
Lokhu kuhlola kunemisebenzi emibili. Ngaphezu kokuhlinzeka ngolwazi lwe-prognostic, uhlolo lubuye lube nemiphumela yokubikezela emiphumeleni yokwelashwa; empeleni ingabikezela impendulo yeziguli ekwelapheni ngamakhemikhali.
Ngamafuphi, i-Oncotype DX iyithuluzi elikabili lokubikezela nokubikezela.
U-Amy Cyr uthe ikhono lakhe lokubikezela impendulo yokwelashwa "into eyenze yagqama kuze kube manje." Wengeze ngokuthi ezinye izivivinyo zamangqamuzana zomdlavuza webele, okuhlanganisa iMammaPrint, Prosigna, EndoPredict, kanye neCancer Index, azizange zibonise ubufakazi bawo womabili la makhono.
o i-ncotype DX ifanele abesifazane abathola i-hormone positive postmenopausal abanomdlavuza webele (futhi ifanele i-HER2 negative, pT1, PT2, noma pT3 kanye ne-pN0 noma i-pN1).
UDkt Cyr uthe imakethe yokuhlola iyakhula njengoba abesifazane abaningi betholakala benomdlavuza webele besebancane, okuyinkomba yomkhiqizo, ngokuhlolwa kwebele.
UDkt. Cyr uthe ukuchazwa kwenkulumo yamangqamuzana “kungenye yezimpumelelo ezijabulisa kakhulu” ku-oncology yezokwelapha, futhi ukuhlolwa okuningi komdlavuza webele kulethe idatha eyengeziwe.
"Ukuhlolwa kwe-Oncotype DX kuyithuluzi eliwusizo kakhulu," kusho uMichael Stone e-Glealey Clinic e-University of Colorado engqungqutheleni, ebikezela ingozi yokuphindaphinda kwendawo noma ye-metastatic. “Iziguli zami eziningi ziyajabula ngokuthi kungenzeka azidingi ukwelashwa ngamakhemikhali.”
UDkt. Stone wachaza ukuthi ukwelashwa ngamakhemikhali ngokuvamile akunconyelwe ezigulini ezinenani eliphansi lokuphindaphinda, kodwa kunconywa ezigulini ezinamaphuzu aphezulu okuphindaphinda. Nokho, amaphuzu okuphinda ayindawo empunga. Uthe uncoma ukwelapha ngamakhemikhali ikakhulukazi iminyaka yesiguli kanye nempilo. I-Chemotherapy ngokuvamile inconywa ezigulini ezisezincane, ezinempilo zangemva kokuya esikhathini esinemiphumela emaphakathi yokubuyela emuva. UDkt Cyr uyavuma ukuthi kunzima ukwazi ukuthi abesifazane abanamaphuzu aphakathi kokuphindeka kufanele bathole ukwelashwa ngamakhemikhali.
U-Cyr ugcizelele ukuthi nakuba i-oncotype DX ifaneleka kuphela iziguli ezingenayo i-lymph node, ibonakala iwusizo ezigulini ezine-lymph node.
Ucaphune ucwaningo lwe-TransATAC, oluqondise abesifazane abanomdlavuza webele we-postmenopausal abaphathwa nge-anastrozole noma i-tamoxifen (J Clin Oncol. 2010; 28: 1829-1834). I-Oncotype DX yasetshenziswa ukuze kuhlaziywe izicubu zesimila ezigulini, futhi ukuphindeka kweziguli ezine-lymph node negative kanye ne-lymph node positive kubalwa ngokulandelana.
UDkt. Cyr uthe "isilinganiso sokuphindaphinda singasetshenziswa njengesibikezelo somphumela wesikhathi eside kuwo womabili amaqembu eziguli." Kuyaphawuleka ukuthi inenani elifanayo lokubikezela ezigulini ezine-lymph node positives ezi-3 noma ezimbalwa kanye nama-lymph node angu-4 noma ngaphezulu.
