Y HOC VIET NAM THANG 11 - S 6 CHUYEN P E - 2015
NGHIEN CU'U DAC DIEM LAM SANG, CAN LAM S A N G CUA UNG THU" PHOI NGUYEN PHAT CT PHU Ntr TAI TRUNG TAM HO HAP - BENH VIEN BACH MAI
Le Hoan*, Le Ngoc Dung**, Vu Van Giap*, Dang Hung Minh*, Ngo Quy Chau*
T6MTAT
Dat van d e ; Ung thu* phoi hien la ung thir pho bien tren the gi6i, ty le mac va ty vong cao nhat the gidi. Hien nay ung thu* phoi ngay cang CO xu hu'dng gia tang d nu* gidl. Muc dich;
nghien ciJu nhu'ng dac diem lam sang va can iam sang cua ung thu* phoi nguyen phat d phu nu*.
Doi tu'dng va phu'dng phap nghien cu'u: hoi cuti mo ta tren 83 benh nhan nu" du'dc chan doan ung thu phoi nguyen phat do tai Trung tam Ho Hap - Benh vien Bach Mai tir thang 1/2013 - 12/2013. Kgt qua: Tuoi trung binh: 60,54 ± 10,96 (tuoi); ty le khong hut chiem 96,4%; trieu chuhg ho hap: dau ngu'c (67,5%), ho i<eo dai (50,6%), khd thd (38,6%); trieu chu'ng toan than: gay sut can (31,3%), hach ngoai bien (18,1%); trieu chiJng Hen quan den siS ian toa tai cho cua u it gap. Chup X-quang phoi chuan: ton thu'dng phoi phai (32,5%) gap nhieu hon phoi trai (21,7%). Chup CLVT; Kich thu'dc u nho nhat ia 1cm va Idn nhat la 9cm 33,9% co u < 3 cm va 38,7% cd u >3 cm hay gap nhat la thuy du'di phoi trai (24,2%), dau hien lan tran ciia u: tran djch mang phoi (38,7%); glal phau benh; ung thif bleu mo tuyen chiem ty ie cao nhat (94%);
TNI«1; glal doan IV (53,7%) chiem ty ie cao nhat.
Kel Iu3n: tuoi trung binh cua ung thu' phoi d nif gidi tre hdn, lam sang trieu chiJng hd hap la trieu
* Trung tdm Hd hdp - Bfnh vien Bgch Mai
•• Smh vien Y6 - Bgi hoc YHa Npi 2009-2(115 Chju trach nhiem chinh: Le Hoan
Email; [email protected]
Ngay n h j n bai: 19/9/2015
Ngay phan bi?n khoa hpc; 10/10/2015
Ngay duy?t bai: 19/10/2015
chuTig chil yeu, cd dau hieu cua xam lan va dl can nhu'ng it gap, UTBi^ tuyen chiem ty le cao nhat va khi den vien hau het la giai doan muon.
Tir khoa; Ung thu* phoi, nU gidl
SUMIVIARY
CLINICAL CHARACTERISTICS, SUBCLINICAL CHARACTERESTIC OF PRIMARY LUNG CANCER IN WOMEN
Purpose: Review clinical characteristics, subclinicai characteristics of primary lung cancer In women. Subjects and jvlethods: Descriptive study of 83 female patients were confirmed primary lung cancer In Respiratory Center at Bach Mai hospital from 01/2013 to 12/2013.
Results: Clinical characteristics; average age 60354 ± 10,96; primarily respiratory symptoms:
chest pain 6735%, chronic cough 5036%, dyspnea 3836%; the general symptoms: Weight loss 3133%; the spread of tumors; hoarseness 834%. Subclinical characteristics: 3838% of patients with T4, lymph node metastasis status:
4633%. Histopathoiogy: Adenocarcinoma 94%;
234% squamous cell, small ceil of 336%.
Keywords; Lung cancer, women
I. OAT VAN e l
Trong nhihig nam gan day, xu hirdng mic va tu vong do ung thir phoi noi chung va nam gicfi noi rieng cd xu hudng giam va dn dinh. Tinh hinh mjc va tii vong do UTP a ntt khong ngimg gia tang.
Theo GLOBOCAN 2012, sd mdi mic
UTP hem 1.8 trieu ca (chidm 13%). so tu
vong do ung thu phoi chiem 19,4% tong sd
CHAO M O N G HQI NGH! KHOA HOC THlfdNG NI^N HOI H 6 HAP V1|T NAM tu vong do ung thu. Trong do UTP nii gioi
CO s6 mSc chiSm 8,8% (dung thur 3 sau ung thu vu, dai true trang va co tvr cung) nhung s6 tu vong chi dung sau so tir vong do ung thu vu [1]. Theo cac ghi nhan ung thu mai nhdt tai Viet Nam, sau 10 nam tir 2000 dSn 2010, ty le m k UTP a nu da tang hon 200%
(6,4/100.000 nam 2000 d^n 13,9/100.000 dan nam 2010).
Theo nhieu bao cao da cong b6, ung thu phoi a nQ" co mot so khac biet so voi ung thu phoi nam nhu: it trieu chung hon, ty le gap ung thu bieu mo tuyen nhieu hem, thai gian s6ng them dai han, mot so yeu to noi tiet anh huang den ty 1? mkc benh ciing nhu kk qua dieu trj d?c bi?t la estrogen. Nham tim hieu them mpt so khia cgnh trong ung thu phoi a phy nii chiing toi tien hanh nghien cuu; "Dgc diem ldm sdng vd cdn ldm sdng ung thw phoi nguyin phdt & phu nir tgi Trung tam Ho Nip - B^nh viin Bgch Mai"
II. 001 TUpNG VA PHircyNG PHAP N G H I I N COOJ 2.1, Doi tircmg nghiSn cu'u
Gom 83 b?nh nhan nii dugc chan doan xac djnh ung thu phoi nguyen phat duac dilu tri npi tni tgi Trung tam Ho Hip - Benh vien Bach Mai tu thang 01/2013 d^n thang 12/2013.
2.1.1. Tieu chudn chgn binh nhdn - B?nh nhan diSu tri noi tni tgi Trung tam HoHSp
- Ket qua giai phau benh khSng djnh la ung thu ph6i nguyen phat.
- Benh nhan nii
2.1.2. Tieu chuin lo^i tru- b^nh nhdn - B?nh nhan nam.
- Nhting trucmg hgp ung thu ph6i thii phat.
2.2. Phirffng phap nghien cihi 2.2.1. Thiet ki nghien ct^u: Nghien cuu hoi ciru mo ta chiim ca benh.
2.2.2. Cdch thirc tiin hdnh: Thong tin benh nhan dugc khai thae bao g6m:
- Tuoi, gicri, nghl nghiep, dia chi, ngay vao vien va ngay ra vien.
- Ly do vao vien.
- Thai gian tii khi hkt dau xuat hien tri?u chung den khi kham benh
- Tien su: hiit thuoc la, thuoc iao, s6 bao nam, mac cac benh ly truac do (dac bi^t la bpnh ho hap).
Trieu chimg c a nang:
+ Trieu chimg ho hap: ho, ho mau, khgc dom, kho tha, dau ng\rc...
+ Trieu chiing toan than: mpt moi, sot, gay sut can. dau co xuong khop, hach ngogi vi...
- Kham th\rc th^:
+ Bieu hien toan thkn nhu: thieu m^u, da xanh, hgeh thugng don...
+ Cac tripu chiing ciia s\t chen ep va lan rpng ciia khoi u nhu: hpi chiing chen ep TMC tren. chen ep vko ckc than kinh, chen ep tim ...
+ Cac hpi chiing cgn u: hoi chimg Pierre - Marie, tang Caxi huySt...
+ Cac bieu hien di can: n3o, xuong, gan...
•f- Cac tripu chung khac - Can lam sang.
+ X quang phoi: thay cac hinh anh dam ma. vj tri, kich thuac, so lugng, bien chimg gay xep phoi, trim dich mang phdi....
+ CLVT: thiy vi tri, s6 Iugng, kich thuac, cac hinh anh xam Ikn ciia khoi u vao mang phoi, vom hoanh,...Xac djnh hgeh viing di can.
+ Npi soi phi quan: vj tri t6n thucmg 6 hg phan thuy. dgng t6n thuang nhu phii ne chit hep, de day tir ngoai vao. viem cdp chay mau...
+ Cac phuang phap giiip chan doan mo benh hpc nhu sinh thilt va t l bao hpc hgeh di can, te bao hpc djch mang phoi...
Y HOC Vl|T NAM THANG 11 - SO CHUVgH BE - 2015
+ Cac xet nghiem danh gia su di can xa cua ung thu
• CLVT hay MRI nao.
Xa hinh xuang...
+ Typ mo benh hpc: gom 9 typ theo WHO 1999
+ Danh gia giai doan theo TMN theo UICC 2009
III. KET QUA
3.1 Dac diem Iam sling - Tu6i trung binh: 60,54 ± 10,96 (tu6i).
- Tiln sir hut thufic la, thu6c lao: co hiit 3/83 (3,6%), khong hiit chiim 96,4%
- Tripu chiing ho hap: dau nguc (67,5%), ho keo dai (50,6%), kho tho (38,6%) - Tripu chiing toan than:gdy siit can (31,3%), hgeh ngogi bien (18,1%).
- Tripu chimg liSn quan den sy lan toa tai cho cua u: khan tieng (8,4%), cac trieu chiing khdc it gap.
3.2 D^c diem cgn Iam sang
- Chup X-quang ph6i chudn: ton thuang phdi phai (32,5%) ggp nhilu han phoi trai (21,7%)
- Npi soi phi quan:
•I- V} tri ton thuang: thiiy gi&a phai (40,5%), thiiy dudi trai (32,4%), thiiy tren phai (24,3%), thiiy duoi phai (24,3%), thiiy tren trdi (23,4%), phi quan g6c trai (21.3%), phe quan g6c phai (8,1%), khi quan (2,7%).
+ Dgng t6n thuang hay ggp nhilu nhatla ton thuong de ep tir ngoai va tham nhiem (29,7%), phil nl chit hep (27%)
- Chup CLVT:
f Kich thu6c u: duang kinh nho nhdt la 1cm va ldn nhdt la 9cm. 33,9% co u < 3 cm va38,7%c6u>3cm.
-^ Vj tri: thuy dual ph6i trai (24,2%), thiiy tren ph6i trai (22,6%), thiiy tren ph6i
phai (21%), thuy duoi ph6i phai (17,7%), thity giiia phoi phai (14,5%)
+ Dau hien lan tran cua u: tran dich mang phoi (38,7%), xam ldn mang ph6i la tang (33,9%), n6t u nho a thiiy khac (29%), xep ph6i (19,4%).
+ Hach: khong phat hien (64,5%), trung that cimg ben (29%), trung thdt d6i ben (11,3%).
- Giai phau benh: ung thu bieu mo tuyln chiem ty le cao nhat (94%), ung thu bieu mo vdy (2,4%), 3,6% ung thu tl bao nhd.
- Danh gia TNM: giai doan IV (53,7%), giai doan III (22,5%), giai dogn II (6,3%), giai dogn I (17,5%).
IV. BAN LUAN
4.1. Dac diem chung
Trong nghien ciiu chiing toi gap bpnh nhan tre nhat 29 tuoi. cao nhat 83 tuoi. tuoi trung binh la 60,54 ± 10,96 (tuoi), trong do 95,2% benh nhan tren 40 tuoi. So sanh voi mgt so nghien ciiu ve UTP, chiing toi nhgn thay tuoi trung binh a nhom doi tugng la phy nii mac UTP tre han so voi nhom bpnh nhan mdc UTP noi chung. Nguyen nhan cua sy tre hoa a cac benh nhan nii bi UTP co the do ty le hut thuoc la chu dong va thy dgng 6 phu nu: tang. Mpt so nghien cim dich te khdng dinh rang nguy ca tuang doi mdc UTP ciia nii gioi cao hon nam giai 1,5 - 2 lan khi ciing phai nhiem voi mpt yeu to nguy ca la hiit thuoc la [2].
Tu6i trung binh nhom nghien ciiu ciia
chiing toi thap hon so voi ket qua ciia mpt so
tac gia tren the gioi.Theo Jennifer. B Fu
(2005) ghi nhgn dp tuoi trung binh ciia
81.843 benh nhan nu- la 66 [3]. Nguyen nhan
cua sy khac biet nay co the dugc giai thich
bai ty le hut thuoc la a phy nG cac nuoc
phuang Tay cao hon chiing ta, tuoi thp trung
CHAO MiTNG HOI NGH] KHOA HOC THUdNG N I S N HOI HO HAP VlgT NAM
binh cao hon, su khac nhau ve khu vyc dia ly, chung tpc va dieu kien song.
Hiit thuoc da dugc coi la nguyen nhan cua khoang 90% nhiing ca ung thu phoi moi mac. Trong nghien ciiu ciia chiing toi chi gap 3 benh nhan hiit thuoc (3,6%). Nghien ciiu ciia Doan Trung Hipp (2011) co 2/50 benh nhan nii hut thuoc la [4]. Trong khi do, nghien ciiu cua Michex Grivaux (2004) ghi nhgn ty le phy nii hiit thuoc la la 48,5%, khong hut thu6c la 32,3% [5].
Qua day chiing ta co t h i thdy ring ty le bpnh nhan hiit thuoc la a nG cua chiing ta thdp hon so voi cac nuoc tren thi gioi dac bipt la khu vyc Chau Au - My. Tuy nhien can luu y rdng ta mai chi xet den van de hiit thuoc la chu dpng. Hiit thuoc la thy dpng cung dugc khdng djnh la yeu to nguy co cao ciia UTP. Nhiing vdn de nay chua dugc danh gia day dii tgi Viet Nam.
KSt qua nghien ciiu ciia chiing toi ghi nhan cac tri^u chirng ho hap van la cac tripu chiing hay gap nhdt. Dau ngyc, ho keo dai.
kho tho va gay siit can la nhiing bilu hien lam sang thuang gap nhdt, trong do tripu chirng dau ngyc g | p a 67.5% bpnh nhan, ho keo 50,6%, kho tha gap 38,6%. Cac ddu hieu toan than nhu gdy sut can la 31,3%; hach ngogi bien la 18,1%; s6t la 9.6%, cac trieu chiing khac it gap
4.2, D^c diem can Iam sang
Trong nghien ciiu cua chiing toi 62/83 bpnh nhan (77,5%) dugc chup CLVT Idng nguc, CO 45/62 bpnh nhan (72,6%) co hinh anh u ro. U co duong kinh nho nhdt la 1cm va lan nhdt la 9cm. 33,9% benh nhan co u <
3 cm va 38,7% benh nhan co u >3 cm.
Nghien cim v l UTP ciia Tran Nguyen Phu (2005) tren 46 bpnh nhan dugc chdn doan UTP tgi Trung tam Ho hdp Bpnh vien Bgch
Mai ghi nhan 33/46 truong hgp (71,7%) co u
>3cm [6]
Ket qua nghien ciiu ciia chiing toi ghi nhan ung thu bilu mo tuyln g | p vcri ty le cao nhat (94%). So sanh vai cac nghien ciju nuac ngoai, ket qua cua chiing toi gan giong voi mpt so nghien ciiu tren the gioi: nghien ciiu UTP a nu tgi Phap (n=904) ciia Michex Grivaux va cgng su (2004) thdy ung thu bilu mo tuyen 43,4%, ung thu bieu mo vay 23,4%, ung thu t l bao nho 16,1% [5]. Jenifer B va cgng sy nghien ciiu UTP a 81.843 b^nh nhan nii ghi nhgn ty le ung thu bieu mo tuyen la 44.7%, ung thu bilu m6 vay 21,4%.
ung thu t l bao nho 22,6% [3].
Nhgn thay trong nghien ciiu ciia chiing toi va cac lac gia khac. mo bpnh hpc ung thu bieu mo tuyen a ung thu phoi phy nH chiem ty ip cao nhat. Dieu nay hoan toan phii hgp voi nhan dinh co sy khac biet phii hgp trong viec phan bo cac loai md bpnh hgc ciia ung thu phdi giGa nam gioi va phy nG. Ung thu bieu md tuyen dk thay the ung thu bilu m6 tl bao vay la logi mo hpc ph6 biln nhdt doi vin ck nam va nG, nhung ty Ip phy nG dupe chdn doan ung thu bieu md tuyen cao hon nam gicfi. va d nam gidi ty le ung thu phdi bieu md vay gap nhilu hon phy nG [2],
Giai thich cho sy khac bi^t trong phSn phoi cac tip md benh hpc cua ung thu phoi giGa nam giai va phu nG cd the do lien quan den gidi ttnh. sy nhay cam khdc nhau khi ciing phai nhiem vdi mgt ylu t l nguy ca - hut thude la hoac chat gay ung thu tiem nang khac. Theo nghien ciiu cua Hiroya Minami (2000): Trong nhom phu nG khdng hiit thuic la (n= 198) ung thu biSu mo tuyln 93,4%, ung thu bieu md vay 3 % . Ty Ip ung thu bieu md vay cao han d nhutig nguoi hiit thuoc so vdi ngudi khdng hiit thude (p< 0,05) [7].
Y HOC Vl|T HAM T H A N G 11 • SO CHUYEN DE - 2015
Cung CO thi cd su khac biet trong dot biln gen giGa hai gidi. Vi dy, thu thi tang trudng bilu bi (EGFR) dpt biln phd biln han 6 phy nG va ngudi khdng hiit thude. Cd sy khac biet trong ty le K-ras hoac EML4 - ALK dpt bien giGa phu nG va nam gidi. Mdt nguyen nhan nua dugc dua ra mac du chua dugc chiing minh hoan toan dd ia estrogen CO the anh hudng mo hgc va cac tinh nang phan tfir cua ung thu phdi [8].
Trong nghien cihi cua chiing tdi ghi nhan c6 80/83 bpnh nhan la ung thu bieu md khong tl bao nhd dugc phan logi giai dogn TNM theo AJCC va UICC 2009. Phan tich ket qua thu dugc. chiing tdi ghi nhgn UTP giai dogn IV chiem ty Ip cao nhat 53,7%. Ket qua nay phii hgp vdi mdt s6 tac gia: Nghien ciiu tr6n 81.843 bpnh nhan nG mdc UTP. tac gia Jenifer B va cdng sy (2005) ghi nhan giai dogn IV chiim 43,9% [3].
V. K^ LUAN
- D^c diem Iam sdng: Tudi trung binh:
60,54 ± 10,96 (tuli). thdp nhdt 29 tudi, cao nhdt 82 tudi. Ty Ip khdng hut chiim 96,4%.
Tripu chirng lam sang: dau ngyc (67,5%), ho keo ddi (50,6%), khd thd (38,6%). Trieu chiing todn than:gdy siit can (31,3%), hgeh ngogi bien (18,1%). Tripu chiing lien quan din sy Ian tda tgi cho cua u it g^p.
- D$c dilm can ISm sing: Kich thude u tren CLVT: dudng kinh nhd nhdt la 1cm va Idn nhdt Id 9cm. 33.9% cd u < 3 cm va 38.7% cd u >3 cm. Hay gap d thuy dudi phdi trai (24,2%), thuy tr6n phdi trdi (22.6%). Dau hipn lan tran cua u: tran dich mdng phdi (38.7%), xam ldn mang phoi la tgng (33,9%).
ndt u nho d thuy khac (29%). Giai phdu benh ung thu bieu mo tuyen chiem ty le cao nhat (94%). TNM giai dogn IV (53,7%) chiim ty Ip cao nhat
TAI UEU THAM KHAO
1. lARC (2012). GLOBOCAN 2012. lARC press, Lyon.
2. David Schottenfeld et at (2007). The Etiology and Epidemiology of Lung Cancer.
Lung Cancer: Principles & Practice 3rd Ed, Lippincott Williams & Wilkins, 4 - 1 4 . 3. Jennifer B.Fu et al (2005). Lung cancer in
women: Analysis of the National Surveillance, Epidemiology, and End Results Database. Che.st. (127), pp 768 - 777.
4. Doan Trung Hiep (2011). Mgt .so dgc diem ldm .sdng, can ldm sdng vd ddnh gid ket qud dieu tri ung thu phdi glal dogn III dph^t nir.
Lugn van thgc sy y hgc.
5. Michel Grivaux, Jean Luc Breton, Pierre Bombaron, et al (2004). Lung cancer among women in France. Lung Cancer (45), pp 279 -287.
6. Tran Nguyen Phu (2005). Nghien cm ldm .sang vd phdn logi TNM ung thu phe quan te hdo khong nho tgi B?nh vien Bgch Mai. Luan van tot nghiep chuyen khoa cap (I, Tru"cmg OaihocYHaNoi.
7. Hiroya Minami, Masahiro Yoshimura, Yoshifumi Miyamoto et al. (2000). Lung Cancer in Women. Sex-Associated Differences in Survival of Patients Undergoing Resection for Lung Cancer.
C/jwY, (118). p p l 6 0 3 - 1609
8. North CM, Christian! DC (2013). Women and lung cancer: what is new? Semin Thorac Cardiovasc Surg 25:87.
