Amaphuzu avelele
Ukuqapha kwe-DNA yesimila esijikelezayo (ctDNA) kusuka kumasampula egazi eziguli kunganikeza inani lokubikezela lomdlavuza othuthukile. Ukulandelanisa kanye nokuqapha amazinga okujikeleza kwe-tumor DNA ngokusebenzisa umdlavuza uhambo lokwelashwa kweziguli lungasiza odokotela banqume ubude besikhathi namandla ezinketho zokwelapha.
Kuyini ukujikeleza i-tumor DNA (ctDNA)?
I-Curculating tumor DNA (ctDNA) izingcezu ezincane ze-DNA ezichithwa ku- umdlavuza amaseli egazini. I-DNA itholakala kakhulu ngaphakathi kwe-nucleus yamaseli kodwa njengoba isimila sikhula, sikhula futhi sithathelwa indawo amaseli amasha, i-DNA ichithwa isuka kumaseli wesimila iye endaweni ezungezile. Inani le-ctDNA lingahluka phakathi kweziguli ezinomdlavuza futhi lizoncika ohlotsheni lwesimila, indawo yaso kanye nesigaba sesifo.
Kusiza kanjani ukuhlolwa kwe-tumor DNA (cTDNA)?
Imininingwane ngobuningi nangokulandelana kwe-ctDNA (Ukujikeleza kwe-tumor DNA) kungasiza ekuxilongweni kwesifo somdlavuza nokubikezela, ukukhetha izinketho zokwelashwa ezikhethiwe kanye nokuqapha okuqhubekayo kwalesi sifo ngomthelela wokwelashwa nokuphindeka.
Kwenziwa kanjani ukuhlolwa kwe-ctDNA nokuhlola?
Ukuhlolwa kwe-ctDNA kungenziwa kusuka kumasampuli egazi ngakho-ke ukuhlolwa kwe-tumor test okujikeleza kungenziwa kaningi ngesikhathi sesiguli somdlavuza. Ukuhlolwa kwe-ctDNA egazini kungenziwa ngokuya ngamasu ahlukahlukene kufaka phakathi i- i-biopsy ewuketshezi nendlela yokulandelana noma inqubo ebizwa nge-digital droplet polymerase chain reaction (ddPCR). Indlela yokulandelana kwe-liquid biopsy inikeza imininingwane eningiliziwe ngokuningiliziwe kokushintshwa kofuzo kuzakhi zofuzo zomdlavuza ezivivinywayo, kuthatha isikhathi eside ukubuyisa imiphumela futhi kungabiza kakhulu, kungakho kungenzeki ukwenza kaningi. Inqubo ye-ddPCR ayinikezi imbumbulu yolwazi umuntu angayithola ngendlela yokulandelana kepha unesikhathi esifushane sokuguqula isimo, eshibhile futhi esinamathuba amaningi okubuyiselwa, ngakho-ke singenziwa kaningi phakathi nohambo lwesiguli. Indlela ye-ddPCR inganikeza imininingwane ngobuningi be-ctDNA egazini kepha ngeke ikwazi ukunikeza imininingwane ethile ngohlobo lwe-ctDNA ngaphandle kwalapho isampula ilandelana.
Ukudla Okufanele Ukudla Ngemuva Kokuxilongwa Komdlavuza!
Akukho mdlavuza owodwa ofanayo. Dlulela ngale kwemihlahlandlela ejwayelekile yokudla kuwo wonke umuntu futhi wenze izinqumo ezenziwe ngezifiso ngokudla nezithasiselo ngokuzethemba.
IDEA Study - ctDNA (circulating tumor tumor) Ukuhlolwa kuCancer Colon
Isivivinyo somtholampilo sakamuva seSigaba III IDEA-France (International Duration Evaluation of Adjuvant (IDEA)) seziguli zomdlavuza we-Stage III, sihlolisise umthelela wezinyanga ezimfushane (izinyanga ezi-3) uma kuqhathaniswa nezinyanga ezinde (eziyisithupha) zesikhathi se-oxaliplatin based chemotherapy adjuvant treatment ku ukusinda okungenazifo. Kulolu cwaningo, abaphenyi baphinde bahlaziya i-ctDNA yeziguli ngaphambi kokuqala i-chemotherapy (U-Andre T. et al, J Clin. I-Oncol., 2018). Imininingwane nokutholakele kokutadisha nokuhlaziywa kwamazinga e-ctDNA ngokusinda kwesiguli kunjengokulandelayo:
- Inani leziguli ezingama-805 zahlaziywa amasampula egazi e-ctDNA (ejikeleza isimila se-DNA) ngaphambi kokuqala ukwelashwa ngamakhemikhali. Kulezi ziguli ezingama-696 (86.5%) kwakuyi-ctDNA negative kanti i-109 (13.5%) yeziguli yayine-ctDNA positive.
- Labo abanezicubu ezinhle ze-ctDNA kutholakale ukuthi banezicubu ezithuthuke kakhulu ngokuhlukaniswa okungalungile.
- Izinga lokusinda lamahhala leminyaka emibili le-ctDNA lalingama-2% kanti eleziguli ezingezinhle ze-ctDNA lalingama-64%.
- Umkhuba wokunciphisa ukusinda kwezifo waqashelwa ezigulini ezine-ctDNA ezazisengozini enkulu noma esezingeni eliphansi le-III colon. umdlavuza, njengoba kuqinisekiswe ukuhlaziywa kwe-multivariate.
- Isiphetho sabaphenyi besifundo se-IDEA ngokusetshenziswa kwe-oxaliplatin njenge-adjuvant izinyanga ezintathu noma izinyanga eziyisithupha kwaba ukuthi izinyanga eziyisithupha zaveza imiphumela engcono kunokwelashwa kwezinyanga ezintathu, zombili ezigulini ezinamasampula amabi we-ctDNA noma amasampula amahle e-ctDNA. Kodwa-ke, umehluko wokusinda weminyaka emi-3 phakathi kwenyanga engu-6 vs inyanga engu-6 yokwelashwa kwe-oxaliplatin adjuvant bekungama-3% kuphela kanti ukusinda kwamahhala kwezinyanga eziyisithupha neminyaka emi-3 kungama-6% nenyanga engu-3 kube yi-3.6%.
Isiphetho Esifundweni
Idatha ekuhlaziyweni kwe-ctDNA evela kukholoni yocwaningo lwe-IDEA umdlavuza iziguli, kanye nokuhlotshaniswa nokusinda okungenazifo, kwethulwa eNgqungqutheleni ye-ESMO ngoSepthemba, 2019 (Taieb J et al, Abstract LBA30_PR, ESMO Congress, 2019). Le datha iyabonisa ukuthi ukuhlolwa kwe-ctDNA nge-ddPCR kungaba umaka ozimele wokubikezela umdlavuza oseqophelweni eliphezulu. Ukulandelana nokuqapha kwe-ctDNA (I-Circular Tumor DNA) ingahlanganiswa ekuhambeni komsebenzi kokwelashwa kwesiguli somdlavuza futhi ingasiza odokotela banqume ubude besikhathi namandla okwelashwa kwe-adjuvant isiguli esizoyidinga, ngokusekelwe emazingeni e-ctDNA ngaphambi kokuqala ukwelashwa.
Ukudla okudlayo nokuthi yikuphi okunezelayo okwenzayo yisinqumo osithathayo. Isinqumo sakho kufanele sifake ukucutshungulwa kwezakhi zofuzo zomdlavuza, okuwumdlavuza, ukwelashwa okuqhubekayo kanye nezithasiselo, noma yikuphi ukungezwani komzimba, imininingwane yokuphila, isisindo, ubude nemikhuba.
Ukuhlelela okunomsoco komdlavuza kusuka ku-addon akususelwa ekusesheni kwe-inthanethi. Kwenzela wena ukuthathela izinqumo ngokuya ngesayensi yamangqamuzana eyenziwe ososayensi bethu nonjiniyela be-software. Kungakhathalekile ukuthi ngabe uyakukhathalela ukuqonda okuyisisekelo kwamakhemikhali amakhemikhali noma cha - wokuhlelela umsoco ukuhlela lokho kudinga ukuqonda.
Qalisa MANJE ngokuhlela kwakho okunomsoco ngokuphendula imibuzo egameni lomdlavuza, ukuguquka kwezakhi zofuzo, ukwelashwa okuqhubekayo kanye nezithasiselo, noma yikuphi ukungezwani komzimba, imikhuba, indlela yokuphila, iqembu lobudala nobulili.
Ukudla Okungokwakho Komdlavuza!
Umdlavuza uyashintsha ngokuhamba kwesikhathi. Enza ngendlela oyifisayo futhi uguqule umsoco wakho ngokusekelwe kunkomba yomdlavuza, ukwelashwa, indlela yokuphila, okuncamelayo kokudla, izinto ezingakuphathi kahle nezinye izici.
Iziguli ezinomdlavuza ngokuvamile kufanele zibhekane nokuhlukile imiphumela emibi ye-chemotherapy ezithinta ikhwalithi yempilo yazo futhi zibheke ezinye izindlela zokwelapha umdlavuza ukudla okunomsoco nezithasiselo ezisuselwa ekucabangeni kwesayensi (ukugwema ukuqagela nokukhetha okungahleliwe) yikhambi elingcono kakhulu lemvelo lomdlavuza nokwelashwa okuhlobene okuqhamuka uma udla imishanguzo.