Y HOC VIET NAM THANG 5 - SO 2/2015
TAI LIEU T H A M KHAO
1 . Biii Dieu (2003), "Ung thu'vu". Thuc hanh xa tn benh ung did. Nha xuat ban Y hoc. 327-337.
2. Thang V.H., Skoog L., Luu H.N. et al (2014),
"Long-term breast cancer survival in Vietnamese women". Breast J. 20(3): p. 333-5.
3. Tr3n Van Thuan ( 2 0 0 5 ) , "Danh gia ket qua dieu trj bd trO bang hoa chat phac do AC ket hdp vdi lieu phap noi tiet tren benh nhan UTV giai doan II-III cd thy the estrogen du'dng tinh", luan an tiS'n sy Y hgc, tri/dng dai hpc Y Ha Noi.
4. Parise C.A., Caggiano M. (2014), "Breast Cancer Survival Defined by the ER/PR/HER2 Subtypes and a Surrogate Classification according to Tumor Grade and Immunohistochemical
^\omaxV&ri\ J Cancer Epidemiol. 2014: p. 469251
Lin N.U., Vanderplas A., Hughes M.E., et al (2012), "Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network". Cancer 118(22): p. 5463-72.
Gennari A., Sormani M.P., Pronzato P. et al (2008), "HER2 status and efficacy of adjuvant anthracydines in early breast cancer: a pooled analysis of randomized trials". J Natl Cancer Inst.
100(1): p. 14-20.
Livi L, Meattini I., Saieva C. et al. (2012),
"Prognostic value of positive human epidermal growth factor receptor 2 status and negative homione status in patients with Tla/Tlb, lymph node-negative breast cancer". Cancxr. 118(13): p.
3236-43
DAC DIEM LAM SANG, CAN LAM SANG UNG THIT GIAP TRANG D i r g e PHAU THUAT TAI BENH VIEN DAI HOC Y H A N O I
Tran Van Thong*, Le Van Quang**, Dinh XuSn Cirfrng***
T O M TAT
MMC tieu: Nhan xet mpt s5 dac diem lam sang, can lam sang ung thu' giap trang du'dc phau thuat tai Benh vien Dai hpc Y Ha Npi. Do! tu'dng va phu'dng phSp: nghien cuU mo ta 70 benh nhan chan doan UTTG duyc dieu til tai B$nh vien Oai hoc Y Ha Noi tiy 01/2012 den 05/2014. Ket qua: tudi trung binh la 43,27± 14,71; ty I? nam/niJ la VA; U vung c6 chiem ty le cao nhat 90%, 1 u tren lam sang 77,14%, ty le u thuy phai va thuy trai tuUng du'dng nhau. U kich thu'dc 2-4 cm chiem 54,29%, u ciitig chSc 90%, u ranh gidi ro 91,43%, u di dong 90%; hach co 32,86%. Ket qua sieu am, u TIRADS 4 chiem 71,05%, u ddn dpc 62,86%, u hai thiliy 27,14%; hach co tren sieu am la 38,57%, hach mpt ben 81,48%; Xet nghiem te bao hoc tai u du'dng tinh la 90%; 100% du'dng ti'nh tai hach. K§t l u | n : trieu chutig lam sang chu yeu cua ung thu" giap trang la sd thay u viing tuyen giap, sieu 3m viJng co v3 chpe tB bao tai u va hach co vai tro quan trpng trong chan doan.
TWkhda: Ung thu' giap tmng, lam sang, can lam sang.
* Benh vl^n Ung budu Nghe An
** Khoa Ung b&du va CSGN- Benh vien DHY Ha Noi
***BpnhvipnK Chju trach nhi^m chinh:
Email: [email protected] Dt: 0912884668 Ng^y nh|n bai: 3/3/2015
Ngay phan bien khoa hpc: 1/4/2015 Ngay duy?t biii: 6/4/2015
S U M M A R Y
THE CLINZCO-PATHOLOGICAL CHARACTERISTICS OF T H Y R O I D CANCER
WERE TREATED I N H A N O I MEDICAL U N I V E R S I T Y HOSPITAL
Objective: Remarks on the clinical characteristics, subclinical thyroid cancer treated' in Hanoi Medical University Hospital from 01/2012 to 05/2014. Subjects and Methods: 70 patients with thyroid cancer were treated at Hanoi Medical University Hospital from 01/2012 to 05/2014. The restrospective descriptive study. Results: Mean of age 43.27 ± 14.71; male: female 1/4; neck tumor accounted for the highest percentage 90%; solitary tumor was 77.14%, the ratio of the right lobe and left lobe tumors was the same; 2-4 cm sized tumor was 54.29%; 90% solitary tumors, bilateral tumor 91.43%; neck lymph nodes 32.86%; Ultrasound, TIRADS 4 tumor was 71.05%, solitary tumor was 62.86%, bilateral tumor was 27.14%; 38.57% had lymph nodes; 81.48% ipsilateral nodes. Cytologicatly, malignant tumor was 90%; 100% positive lymph node. Conclusions: Clinical palpation was the most common presentation of thyroid cancers. Neck ultrasound and lymph node/tumor fine aspiration cytology have an important role In diagnosis.
Keywords: Cancer of the thyroid, clinical, paraclinical characteristics.
Y HOC VIET NAM THANG 5 - SO 2/2015
I. BAT VAN BE
Tren the gidi cung ntiir 6 Viet Nam, UTTG chi cliiem 1-2% trong tat ca cac loal ung thy, nhu'ng la ung thu' pho bien nhat cua he noi tiet, chiem t(3i 90% va ty ie tir vong chiem_ 63%
trong tong so tir vong do ung thu' tuyen noi tiet[l]. Theo thong l<e tai My nam 2011, co Ichoang 48.000 ca mdi mac va ti ie nam/nif l<hoang 1/3,1[2]. 6 Viet Nam, theo tac gia Nguyen Quoc Bao nam 2010 ti le mac d nam gidi l<hoang 1,8/100.000 dan, 6 nif Jthoang 5,6/100.000 dan [3]. UTTG thu'cing bleu hien bang khoi u giap is giai doan sdm hay chi Ja hach CO di can ddn doc, hoac mot ung thu'_bieu hien ro tren lam sang vdi day dii tinh chat ac tinh. Viec chan doan ung thu' giap trang tu'dng doi d l dang diJ^ vao lam sang va can lam sang nhu sieu am viing co, te bao hpc khoi u hoac hach vdi do nhay va do dac hieu cao [4].
Tai khoa ung bu'du va cham soc giam nhe benh vien Dal hpc Y Ha Npi, ty le benh nhan ung thu' giap trang den kham va dieu tri ngay mpt tang, tuy nlilen chua cd nghien ciru naove mat lam sang cung nhu' cac xet nghiem can lam sang doi vdi loai benh nay. Nham nang cao chat lu'dng chan doan cung nhu' dua ra phac do dieu tri phii hdp ngay tir ^n dieu tri dau ten de tranh phai mo lai hoac dieu trj lan dau khong hoan chinh se anh hu'dng tdi ket qua dieu trj, do dd chung toi thirc hien nghien ciru nay vdi muc tieu;
"A/o ta mot so die dii'm lim sang, c$n lam sing urrb talB^nh viin Bai hpc YHi Ngi", II. eoiTUpNG vA PHiraNG PHAP NGHIEN COD
2.1. Bol tirong nghien cuTu
Gom 70 benh nhan chan doan la UTTG du'dc dieu tri tai Khoa ung bu'du va cham soc giam nhe - Benli vien Oai hoc Y Ha Npi tif 01/2012 den 05/2014.
2.1.1. Tliu chuSn chgn binh nhin - Chan doan ung thtf giap trang bang lam sang va can lam sang
- Oifdc dieu trj bang phau thuat
- Chan doan mo benh hpc sau phau thuat la UTBM tuyen giap.
Bing 3.1: Qac diem u tren lam sang
2.1.2. Tliu chuan loal tni; tat ca cac tru'dng hdp khong thuoc tieu chuan lua chon tren.
2.2. Phu'Ong phap nghien cu'u: nghien
ciru mo ta hoi cirtj ^ 2.3. Phu'dng phap thu thap so lieu: Thu
thap theo mau benh an in sin, trinh tif tien hanh theo cac bu'dc sau day ^
2.3.1. Bac die'm chiin doan lim sang:
- Tuoi: chia thanh cac nhdm tuoi; <11 tuoi, tir 11- 20 tuoi, 21- 30 tuoi, 31- 40 tuoi, 41- 50 tuoi, 51-60 tuoi, 61- 70 tuoi va tren 70 tuoi.
- Gldl; nam, nif, ty le nam/nif. ^
- Ly do vao vien; u viing co, hach co, khan tieng, nuot vu'dng
- Tien sir; tia xa viing co, gia dinh
- Thdi gian phat hien benh; tinh tir luc phat hien benh den khi vao vien, du'dc chia nhtf sau; <12 thang, tif 13-24 thang, 25-36 thang va >36 thang,
2.3.2. Can lim sing
* Sieu am tuyen giap danh gia.
+ Ddi vdi u; so lu'dng u, danh gia theo TIRADS. Vj tri u; thiiy phai, thiiy trai, eo, hai thiiy. Kich thu'dc u; chia 3 nhdm < 2cm, tir 2- 4cm, > 4cm
+ 061 vdi hach; so lu'dng hach, vj tri hach (nhdm hach canfi va cac nhdm hach khac)
* Te bao hpc; ung thU, nghi ngd hay lanh tinh
* P"-' • loai mo benh hpc; ung thtf tuyen giap the nhu, the nang, the tiiy va the khong biet hda
III. K f r QUA
3.1. Bac diem lam sang Tuoi, gidi:
Tuoi trung binh la 43,27 ± 14,71 tuoi. Tuoi mac nho nhat la 21, Idn nhat la 80. Ty le nam/nif = 1/4, - Lydo via viin, thdi gian phat Men benh:
SP benh nhan den vien vdi trieu chu'ng u viing CP cliiem ti le cap nhat tren 90 %, hach CP 4,28%, cac trieu chu'ng khac chiem ty 16 thap Oa so benh nhan den vi$n trong 12 thang dau vdi ti le tren 80%, tuy nhien cung co 5,72%
trtfdng hdp phat hien sau 36 thang.
- Bac dlim u trin lim sing
Bac diem u So lu'dng u (n=70)
C d l u
> 2 u Vitriu
SoBN 54 16
Ty le »/o 77,14 22,86
Y HOC VIET NAM THANG 5 - SO 2/2015
U tuyen qiap thiiy (P) U tuven qiap thiiv fT) U hai thiiy tuyen qiap U ep tuyen qiap
39 38 12 5
44,14 43,14 17,14 7,14 Kich thwdc u (n=70)
< 2cm 2- 4 cm
32 38
45,71 54,29 Mitd6u(n=70)
Cimq, chac Mem
65 5
92,86 7,14 Ranh gldl u (n=70)
Ro Khonq ro
64 6
91,43 8,57 Dl dong u (n=70)
Cd di dong Khong dl dong
Bac diem hach tren lam sang Kham phat hien hach
Khong cd hach Cd hach Vi tri hach
Hach canh qiifa Hach canh dtfdi Phoi hdp nhieu nhdm hach Mat do hach
Ctfnq, chac Mem
63 7
47 23 4 2 17 16 7
90,0 10,0
67,14 32,86 17,39 8,70 73,91 69,57 30,43
Nhin xet: so benh nhan phat hien co lu tren lam sang chiem 77,14%, ty le gap u thuy (P) va u thuy (T) gan tu'dng du'dng nhau. Co tren 17% la gap u d hai thuy tuyen giap. Kich thu'dc u da so ti!r 2- 4cm vdi ty le 54,29%, u cCTng chac 90%. U cd ranh gidi ro la 91,43%.
Ty le CO hach co chiem 32,86%, trong dd phoi hdp nhieu nhom hach la cao nhat tren 70%. Oa so hach cd mat do eu'ng, chac chlem 69,57%, hach cd mat dp mem la 30,43%.
3.2. Dac diem c3n I3m sang - Siiu im tuyen glip vi hach co
Bing 3.2: Oac diem u tuyen giap va hach co tren sieu am
Bac diem SoBN %
SS lifting u (n=70) C d l u
>2u Vitriu
U thiiy phai U thiiy trai U hai thiiy U eo tuyen giap KiOi thu'dc u (n=70)
< 2cm
2 - 4 c m
> 4 c m TIRADS (n=3S)
44 26 43 41 19 5 34 33 3
62,86
37,14
61,43
58,57
27,14
7,14
48,57
47,14
4,29
Y HOC VIET NAM THANG 5 - S O 2/2015 TIRADS 3
TIRADS 4 TIRADS 5
Hach phit hien tren sieu im in~70)
Khonq cd hachCo hach
Vi tri hach (n=27) Hach CO mot ben Hach CO hai ben
3 27
8 43 27 22 5
7,90 71,05 21,05 61,43 38,57 81,48 18,52
Nhin xet: ty le co l u chiem da so 62,86% va chu yeu gSp u d thuy phai, TIRADS 4 chiem 71,05%;
kich thu'dc u >4cm chiem ty le thap. Ty le co hach la 38,57% trong dd cd hach co mpt ben chiem da
so vdi ty le 81,48%.- Xet ngliipn te btw lipc
Bang 3.3: Xet nghiem te bao hoc
Te bao hpc Cd te bao ung thtf Khonq cd te bao unq thtfTong
U g n 63 7 70
ap
»/o 90,0 10 100
Hach CO n
• 7 0 7
100
%
0 100
Nhan xet: U giap cd te bao ung thtf gap 90% va co 10% la khong cd te bao ung thtf 100% hach cd te bao ung thtf
- Mo benh hoc sau phau thuat
Tvle 100
80 60 40 20 0
91.43
8.57
Nhu, Nang nhii nang
Mo benh hoc
Nhan xit; ung thtf tuyen giap the nhu chiem da so vdi hdn 90%, tiep den la the nang khonq qap trtfdng hdp nao ung thtf the tuy va khong biet hda
IV. BAN LUAN
4.1. Dac diem lam sang 4.1.1. Tud'i, gidi
Trong nghien cull ciia chung tdi tudi trung binh 43,27 J; 14,71 tuoi, nhd nhat la 21 tuoi va cao nhat la 80 tuoi. Ket qua nay cung phii hdp vdi nghien ctfu ciia Le Van Quang (2001), lira tuoi 21-60 tuoi la 76,6% va dinh cao ciing d nhdm tuoi 31- 40 tudi chiem 29,2%)[5].
Ty le nif trong nghien ctfu ciia chung tdi gap 80%, ty le ntf/nam la 4/1. Ket qua nay cung giong nghien ctfu ciia Nguyen Quoc Bao (2010),
tl le ung thtf giap trang d nam gidi khoang 1,8/100.000 dan, d nif khoang 5,6/100.000 dan [3]. Nghien culi ciia Le Van Quang (2002), ty 18 nif/nam la 2,5/l[5].
'*"'••?• ' f ' ^ " ch&ng lam sang _ Oa so benh nhan den vien vdi ly do xuat hien u giap ddn thuan chiem ty le cao nhai:
(92,86 %), ket qua nay ttfdng ttf nghien ctfu CLia Le Van Quang (2002) tren 3()8 benh nhan ung thtf giap trang dtfdc dieu tri tai Benh vien K, cd 68,5% trtfdng hdp la trieu chutig u giap.
Theo tac gia Hershman va siahd (2005), ti le
Y HOC VIET NAM THANG 5 - SO 2/2015 benh nhan den vien cd tdi 15,2% la chi tinh cd
phat hien qua kham su'e khde [ 6 ] .
Trong nghien cu'u cua chung toi, 100%
benh nhan cd u giap tren lam sang. Ket qua cua chung toi tiTdng tiT nghien cu'u cua tac gia Dinh Xuan Cu'dng (2010) la 96,4% [ 4 ] , Trinh Xuan Du'dng (2012) la 91,5%[7]. Ty le hach tren lam sang chiem 32,86%, tap trung chu yeu vj t r i phoi hdp nhieu nhdm hach chiem cao nhat 7 3 , 9 1 % , trong dd cd 69,57% so hach eu'ng, chac. Ket qua nghien cdu cua Trinh Xuan Du'dng (2012), ty le nhdm hach canh ia 72,7% va cd 5 9 , 1 % tru'dng hdp hach cd dac diem eu'ng chac.
4 . 2 . 0 a c d i e m c a n l a m s a n g - Sieu im tuyen glip
Trong nghien CUXJ ciia chung toi sieu am phat hien du'dc 100% cd u tuyen giap, trong dd ty le 1 u la 62,86% va > 2 u la 37,14%. Ty le gap u d thuy phai la 61,43%, u d thuy trai la 58,57% va u hai thuy la 27,14%, cd 7,14% la u d eo tuyen giap. Hien nay, tai Benh vien Oai hpc Y Ha Npi dang ap dung phu'dng phap danh gia ket qua sieu am tuyen giap theo TIRADS, trong nghien CLTU cua chiing toi t / le gap nhieu nhat la TIRADS 4 vdi 71,05% va TIRADS 5 la 17,86%
c6n cac loai khac rat it gap. Dda vao phan loai theo TIRADS, ngu'di ta biet du'dc kha nang LOTG la bao nhieu % (vf du TIRADS 4a la 20%, 4b la 40%, 4c la 60%...).
Ty le phat hien hach tren sieu am la 27/70 tru'dng hdp du'dc phat hien chiem ty le 38,57%, trong dd ty le phat hien hach cd 1 ben la 81,48%, hach co 2 ben la 18,52%.
- Xet nghiem te bio hgc trWdc md vi mo benh hgc sau md
Choc sinh thiet chan doan bang kim nhd cd gia trj rat cao, dac biet la do! vdi hach ma ket qua t§ bao ung thu" thi chac chan 100% la UTTG.
Trong nghien cdu cda chung toi, tim thay te bao ung thu" doi vdi u giap chiem 90%, doi vdi hach CO phat hien du'dc 100% cac tru'dng hdp. Tuy nhien ket qua con phu thupc vao kinh nghiem, trinh dp cua ngu'di lam thii thuat va ngu'di dpc ket qua. Thong thu'dng chi ap dung vdi nhuhg tru'dng hdp kham lam sang thay u hoac hach, van de ket hdp vdi sieu am dem lai hieu qua cao hdn rat nhieu nhat la nhiJhg tru'dng hdp u cd kich thu'dc nhd. Nhuhg van de nay van chu'a du'dc uhg dung rpng rai.
Ve mo benh hpc chii yeu gap loai ung thu' the nhu, nhu nang va cd 8,57% la the nang, khong co tru'dng hdp nao the tiiy hoac the khong
biet hda. Ket qua nay cd SLT khac biet so vdi ket qua nghien cu'u ciia cac tac gia khac. Theo Nguyen Van Thanh (2000) UTTG the nhii la 81,7%, the nang la 13%. Theo Chir Quoc Hoan (2013) the nhu la 7 7 % va the nang la 14,5%[9].
Sd dt cd SLT khac biet nay do la do cd mau nghien cii'u cua chung toi nho hdn, nhutig nhin chung UTTG the nhii van gap nhieu nhat
V. KET LUAN
Qua 70 benh nhan bj UTTG da du'dc kham va dieu trj tai khoa ung bu'du va cham soc giam nhe-Benh vien Oai hpc Y Ha npi td 01/2012 tdi 05/2014, Chung toi du'a ra nhO'ng ket luan sau.
Tuoi trung binh la 43±14,71 tuoi, ty le ndi nam la 1/4. U viing cd la trieu chu'ng dau t-ien xuat hien vdi ty le cao nhat chiem 92,86%, trong dd cd 1 u la 77,14%, u cd mat dp ran chac la 92,86%. Ty le di can hach gap la 32,86% trong dd hay gap nhat la phdi hdp nhieu nhdm hach 73,91%;lam sang chan doan du'dc co 9 0 % la UTTG va cd 10% la nghi ngd.
Ket qua xet nghiem te bad hpc cd 90% la cd te bao ung thu' va tren sieu am danh gia u tuyen giap gap phan Idn la TIRADS 4 vdi ty le la 38,57%. mo benh hpc chii yeu la ung thU the nhu
TAI UEU T H A M KHAO
1. Max P, Freddie B, Ferly J. (2008). Cancer Statistic 2008. GLOBOCAN CA Cancer J Clin 2008, Paqe 74-108.
2. American Cancer Society. (2011). Thyroid Cancer.
file://www. cancer org/Cancer/fhyroidCancer/Deta liedGuide/thyroid-cancer-key-statistics (Accessed on August 29, 2011).
3. Nguyen Quoc Bao. (2010). Ung thiT tuyen giap.
Oieu tri phau thuat benh ung thd 2010. Nha xuat ban y hpc, trang 92-113.
4. Dinh Xuan Cu'dng (2004) "Nghien ciru dac diem lam sang, mo benh hgc va ket qua dieu trj phau thuat ung thir tuyen giap tai benh vien K" Luan
fan tf)3C5/>/7oc, Ha Noi, 33 - 48.
5. Le Van Quang (2002), "Nhan xet dac diem lam sang va cac phUdng phap dieu tri ung OiU tuyen giap tai Benh vien K tir nam 1992 - 2000", Tap chi
K/jpc, so (431), 323-326.
6. Hearshman 3.M, Blahd W.H (2005). Thyroid gland. Endocn'ne and Neuroendocrine cancer treatment / ' ' eddltion. ED W.B Saunders Company. P 458- 759
7. Trjnh Xuan Du'dng (2012), "Oanh gia ket qua ung thd tuyen giap the nhii tai benh vien K", Luan van thac sty hpc, Ha Ngi.
