DOI vai UNG THU* TUY NGOAI TI^T

TAP CHl NGHIEN CLFU Y HOC

alternative technique If the IVU failed to find the diagnostic. Brushing the urinary tract wall on uroscopy or radioguided procedure to discovery the malign cells should be used to diagnose eariy the HUTT.

Key words: Diagnosis, HUTT, IVU, ultrasound, CT

GlA TRI C H A N D O A N VA T H E O DOI SAU M 6 C U A CA19 - 9

DOI vai UNG THU* TUY NGOAI TI^T

Do Tru'd'ng San Truong Dal hoc Y Ha Ndi

Danh gia hl$u qua cua chit chi diim khii u CAI9-9 trong chin doan va theo doi sau mo ung thw tuy ngoai tiet (UTTNT). Doi twq/ng va phuong phap: Nghien ciru md ta, khao sat ndng do CA19-9 tren nhiing BN nghi ngd la UTTNT, xac djnh dd nh$y (Se), dd d$c hi$u (Sp), do chinh xac (Ace.) cua BN truoc mo (chuan vang:

adenocarrclnome tren kit qua GPBH) va sau mo. Kit qua: 132 BN tren lam sang va sieu am cd diu hl$u nghi ngd ung thw tuy duoc djnh luong CAI9-9 huyit thanh, sau dd doi chiiu vdi kit qua phiu thuat va GPBH. Da xac djnh dwQ/c 76 truong hq/p la ung thw biiu md tuyin ong tuy (adenocarcinoma) va 56 tmdng hap khdng phai la ung thw tuy. Nong do CA19-9 tmng binh cua 76 BN ung thw tuy li 3609,1 ± 10178,6 (n = 76). Niu lay gli tri ngudng (cut-off value) la 75 Ul/ml thi do nhiy cua xet nghiem la 69,7%, do die hieu li 67,8% va gia tri tien doin duong tinh la 74,6%. Sau mo cat u, CAI9-9 giam m^nh tir 90 - 93% so vdi mire trwdc mo (p < 0,05). Kit luin:

Nong do CAI9-9 trwdc mo d BN UTTNT tmng binh la kha cao so vdi binh thudng (3609 U/ml). Xie dinh CA19- 9/huyit thanh la bi$n phip tot giup chin doin UTTNT trudc mo vdi dd nhiy 70%, do die hl$u 68%. Vai trd canh bao tii phat sau mo, UTTNT d nghien ciru niy ehwa dwac chimg minh mdt each thuyit phuc.

TIP khoa: CA 19 - 9, ung thu- tuy ngoai tilt

I. DAT

V A N

Dt

Ung thu tuy ngoai tiet Id mdt benh nang, khd xdc djnh chan dodn vd thudng mo d glal doan mudn, khi ede tridu chirng Idm sang dd qud rd rdng. Ben canh ede phuang tidn chin dodn hlnh anh va ndi soi, tir gan 10 ndm nay Chung tdi da dua vdo SLP dung phuang phdp djnh lugng chit chi diim khdi u CAI9-9 trong huylt thanh bdnh nhdn d l chin dodn ung thu tuy. CAI 9-9 Id mdt khdng nguydn cacbonhydrat laeto-N-Fueopantose II. Khdng nguydn ndy sinh ra tCr nhiiu loai t l bdo ung thu, luu hdnh trong huylt tuang. Che d i n nay, CAI9-9 Id mdt chi diim khoi u dugc lira chpn nhiiu nhit trong ung thu tuy d i phdt hidn, chin dodn vd nhit Id theo ddi k i t qua cOng nhu d i u hidu tdi phdt sdm sau dieu tri phdu thudt.

Nghidn ciPU ndy dugc thyc hidn vdi muc tieu: Ddnh gid vai trd cua chl dilm khoi u

CA19-9 trong chin dodn vd theo ddi dieu tri ddi vdi ung thu tuy ngoai t i l t

II.

D6\ T U ' Q N G V A

PHU'QNG

P H A P 1. Ddi tu'ang

Nhu-ng bdnh nhdn tren Idm sdng vd sieu dm nghi ngd Id ung thu tuy, khdng gidl han tuoi, gidi, ed nhu-ng trieu chu'ng vd dau hieu ggi y nhu dau byng giy siit, hdi ehipng vdng da tie mat thip, sieu dm cd hinh anh dudng mdt gidn din phin thip ong mat ehu, hinh anh tuy ggi y din mdt khoi u. Mdt so bdnh nhdn khdng ed trieu ehipng vdng da tie mat nhung trdn sieu dm hode cliyp elt Idp vi tfnh 6 bung thiy hlnh anh khoi u thude tuy (diu, thdn hode dudi tuy).

2. Phu'ang phap

Tit ca mpi bdnh nhdn nghi ngd ung thu tuy dugc Idm xdt nghidm djnh lugng nong dfl CAI 9-9 trudc mo: Lly 3ml mdu khdng chong ddng ly tdm, tdeh huylt thanh vd bao quan d

TAP CHI NGHIEN CU'U Y HQC •

20°C trong khi chd du so bdnh nhdn d i md mpt "Kit" thuoc thii'. Djnh lugng CAI9-9 trong huylt thanh bing ky thudt ELISA hai giai doan theo nguydn tic sandwich trdn dng phan irng plastic cd gdn streptavidin [4; 5]. Ky thudt cd tinh dae hieu vd dd nhay rit eao nhd sip dyng 2 khdng t h i dan ddng Id khdng t h i khdng CAI 9-9 gdn Biotin vd khdng t h i gin enzym peroxydase. Xdt nghiem dugc tiin hdnh tren mdy ES-33 eua hdng Boehringer Mannheim tai khoa Sinh hod, benh vidn Viet Du'e, Kit enzymum-Test CAI 9-9 eung eua hdng Boehringer Mannheim. Kit qua djnh lugng duge tfnh bing dan vj qudc t l tren mlllllt (Ul/ml). Cde kit qua xet nghidm se duge ddi ehllu vdi chin dodn sau mo, xet nghidm md bdnh hpe. XLP ly thdng kd: Gid tri ehan dodn cua CAI 9-9 ddi vdi ung thu dugc ddnh gid qua cde thdng sd: Dd nhdy (Se), dd ddc hidu Bang 1. K i t qua chdn doan

(Sp), vd gia tri dy bdo duang tinh (PW) vdi ehuan vdng Id k i t qua xet nghidm md bdnh hpc.

III. K^T QUA

132 bdnh nhdn tren Idm sang vd sidu dm ed diu hidu nghi ngd la ung thu tuy (dau byng, sut can, u bung, vang da t i c mdt, sidu dm ed hinh anh u tuy...) da dugc Idm xdt nghidm djnh lugng CAI 9-9, sau dd ddi chilu vdi kit qua phiu thudt vd/hcac kit qua GPBH d l bilt Id cd ung thu tuy hay khdng phai ung thu tuy. Mdt so bdnh nhdn trong so nhirng benh nhdn Id ung thu tuy, sau mo duge Idm lai xdt nghidm CAI 9-9 de ddnh gid su thay doi eua xet nghidm ndy qua thdi gian theo ddi. Dudi ddy Id nhii'ng kit qua ey t h i ehiing tdi thu dugc qua nghien ciPU nay.

cudi cung cua 132 benh nhan*

Chan doan benh cuoi cimg A. Nhdm I: Ung thw tuy ngoai tiet

1. Ung thu biiu md tuyin ong tuy (Adenoeareinome)

6. Nhdm II: Khdng phdi ung thw tuy 2. Vidm tuy man tfnh

3. Sdi phin thip dng mdt ehu 4. Sdi ket Oddi

5. Ung thu dudng mdt 6. U sau phuc mac

7. U td trdng (adenoeareinome) 8. Ung thu mdn vj an vdo d i u tuy 9. Viem tuy hoai tip

10. Nang gia tuy

76 56 26 4 2 6 9 2 3 1 3

57,6 42,4

Tong so 132 100%

* Ghi chu: Tit ca s6 BN n^y dSu cd md va dwac xdc djnh chin docin

1. Gia trj trung binh cua CA19-9 a cac nhdm ung thu'tuy va khong phai ung thu'tuy Nong dd CAI 9-9 cua nhdm I (Ung thu tuy):

Trung binh: 3609,1 U/ml SD: 10.178,6 Min: 1 Max: 65.400,0

24 TCNCYH 74 (3)-2011

- T A P C H l N G H I E N C C P U Y H Q C

N6ng d d C A I 9-9 c u a n h d m II (Khdng phai ung t h u tuy):

Trung binh: 207,4U/ml

SD: 395,9

Min: 0 Max: 1912,2

2. Gia trj chin doan ung thu' tuy cua CAI9-9

Niu lly gid tri ngudng g cdc mire khde nhau (37U/ml, 75U/ml vd 100U/ml) thi se ed ede gid tri chin dodn ung thu tuy sau ddy:

Bang 2. Cac gia trj chdn doan u'ng vai cac gia trj tigu'ang du'ae chpn Gia tri ngu'O'ng

(U/ml) 37 75 100 200

8e (%) 76,3 69,7 67,1 56,6

Sp (%) 55,3 67,8 69,6 75,0

PPV (%) 69,9 74,6 76,0 75,4

NPV (%) 63,3 62,3 60,9 56,0 PPN: Positive predictive value ('g/d trj ti§n iwQng dwong tinh)

NPV: Negative predictive value (giii tri tien dodn d m tinh)

U'ng v d i moi gid tri n g u d n g se c d cde gid tri c h i n dodn. Vide chpn n g u d n g ndo eho phu h g p Id tuy vdo m u c dfch sir d y n g eiia t h i y t h u l c Idm sdng.

Ds^o-ng cong R O C

<o-

o

1 - Dp dac hieu

Bilu dd 1. Du'ang cong ROC cua CA 19-9 3. Gia trj tien lu'ang va theo doi sau m6 cua CA19-9

Trong so 76 bdnh nhdn ung thu tuy dugc Idm xdt nghiem CAI 9-9 trude mo, ed 23 benh nhdn dugc xdt nghidm kiim tra du 2 lan sau mo (sau 2 tudn vd sau 4 tuin). Cde bang dudi ddy cho thiy sy thay dii ndy so vdi trudc khi mo.

Sau m l cdt dugc u, CAI9-9 giam manh, tir 90 - 93% so vdi mire CAI9-9 trude m l . Sy giam ndy cd y nghTa thing kd (p < 0,05).

TAP CHI NGHIEN CCPU Y HOC •

Bang 3. CA19-9 d' 15 benh nhdn ung thu' tuy md cdt du'ae u

Trude mo Sau mo 2 tuin Sau mo 4 tuin

Trung binh 4672,61

452,88 324,06

CAI 9-9 a BN UTT cdt dygc u* (n = Dp lech chuan

12714,72 838,30 769,92

Trung vj 941,00 118,50 15,70

15)

MiPC giam 90,3%

93,0%

*Ghi chu: 14 BN cit khdi ti tuy, 1 BN cit than duoi tuy.

So sdnh trwac md va sau 2 tuin: Test Wilcoxon:

So sdnh trwdc md vd sau 4 tuin: Test Wilcoxon:

IV. BAN LUAN

Ung thu tuy Id mdt bdnh ed tien lugng xiu, mdt trong nhiiu ly do Id benh thudng phdt hien mudn. Ngay nay, mae diu dd ed nhilu tiln bd ddng k i trong ITnh vyc chan dodn hinh anh ung thu tuy nhu sieu dm, SANS, chyp elt Idp vi tinh, MRI, chyp mat tuy ngugc ddng, chyp ddng mach tang chpn lpc..nhung viee chin dodn sdm eung nhu ehan doan chfnh xde ung thu tuy bing ede phuang tfen trdn vin edn Id mdt vin d i khd dat duge.

Lidu cd t h i phdt hidn benh sdm hgn, g giai doan tiln Idm sdng khi khoi u ung thu mdi xuit hidn? Cdu hdi dd da thdi thiic ode nhd nghidn eiPU di tim mdt bidn phdp chin dodn sinh hpe

•"y'\ hy vpng giai dugc bdi todn khd khan ndy.

Vdo giii'a nhti'ng nam 70 cua t h i ky XX, Stehelin vd Michael dd he md tia hy vpng khi cac nhd khoa hpe ndy Idm sdng td ngudn gdc .3 vai trd cua cde chit chi diim khoi u (CDKU

= Tumor markers). Theo quan dilm nay, dudi tde ddng eiia cdc tde nhan gay dot biln, cde gen tiin ung thw (proto-oneogen) se chuyin thdnh cde gen sinh ung thw (oncogen), phd vd qud trinh diiu hod sinh san cd sdn trong ede t l bdo. Cde t l bdo ung thu mdi hinh thdnh ed kha ndng san sinh ra cdc chit dac trung gpi Id khdng nguyen lien kit ung thw (Tumor associated antigens TAA). Cdc chit CDKU ndy dugc xde djnh Id cdc chit ehi diim sinh hpe dac hieu cho phep khang djnh sy tdn tai eua t l bdo khoi u trong eg thi. Do vdy, mdt dinh nghTa tong qudt cho CCOKU Id "NhOng

Z =-3.408, p = 0.001 Z-^-2.840, p = 0.005

dai phan tCr xuit hidn va thay ddi ndng dd trong ca thi sdng, cd lidn quan mdt cdch chic chin ddn sw phat sinh va phdt triin cua khdi u dc tinh trong ca thd dd". Ke tip khi chit CDKU diu tien AFP (Abelev-1965) dugc tim ra, din nay dd cd rdt nhilu cde chdt CDKU duge phdt hidn vd su' dyng trong nhiiu loai ung thu khde nhau vdi muc dich: sdng Ipe ung thu, chin dodn sdm, tien lugng vd theo ddi diin biln benh.

CAI 9-9 Id mdt trong nhii'ng chit CDKU vira neu trdn. Dwac KoprowskI phdt hidn ndm 1979 [6], CAI 9-9 cd elu tao Id khdng nguydn Carbonhydrat vdi ban chit Id glyeopeptid trong dd 5 dan vj dudng lien kit vdi nhau bdi acid sialic vd fueopentose. CAI 9-9 Id chit chf diim dae hieu cho ehan dodn ung thu tuy vdi do nhdy eao. Ngay tCr ndm 1996 ehung tdi da tiln hanh djnh lugng CAI 9-9 ddi vdi nh&ng benh nhdn nghi ngd ung thu tuy. Vdi nghien CCPU

ndy, 132 benh nhdn trdn Idm sdng vd sidu dm nghi ngd ung thu tuy, dd dugc lly mdu djnh lugng CAI 9-9. Kit qua eho thdy:

Nong dp CA19-9 d benh nhdn ung thu tuy:

Nong dp trung blnh CAI9-9 eua nhdm ung thu tuy Id 3609,1 ± 10178,6 U/ml. Khoang biln thidn rat rdng: thip nhit la 1 vd eao nhat Id 64400U/ml. Hodng Vdn San [3] djnh lugng CAI9-9 trdn ngudi binh thudng khoe manh thiy nong dp trung binh Id 0 - 29,56U/ml. Nlu lay mire ngudng binh thudng theo quy udc Chung vin chip nhan Id 37U/ml thi thiy nong dp trung binh ndy eua ung thu tuy Id rit eao.

Bang 2 eho thdy 76,3% sd bdnh nhdn ung hu tuy cd nong dd CA19 - 9 > 37U/ml vd 43,4%

26 TCNCYH 74 (3)-2011

TAP CHI NGHIEN CU'U Y HOC ndm trong khoang > 500U/ml.

Nhu vdy, nlu lay ngudng dm tinh Id

< 37U/ml thi ty Id xdt nghidm CAI 9-9 dm tinh se Id 23,7%. Ty Id ndy Id cao so vdi nhilu tdc gia khde [7] [8]. D i i u ndy cd t h i cd lidn quan din y l u t l nhdm mdu Lewis (nhdm Le[a-b-]) md trong nghidn cu-u ndy chiing tdi dd khdng tfnh trudc. Theo Trin Van Be [1] ty Id ngudi Vidt Nam cd mau nhdm Le(a-b-) Id khd cao (16,18%). Trong Id bdnh nhdn nghidn cO-u cua Tian [10] cd 4 bdnh nhdn ung thu tuy thudc nhdm mdu Le(a-b-), ea 4 bdnh nhdn ndy cd CA19-9 d i u d mire <

37U/ml (xdt nghidm dm tfnh).

Nong dd CAI9-9 edn phy thudc vdo tinh trang tic mat. Nguyin Viet Dung [2] nghien ciPU nong dp CA19-9 d 3 nhdm doi tugng khde nhau: nhdm ung thu tuy, nhdm khdng phai ung thu tuy nhung ed vdng da tie mat vd nhdm khdng phai ung thu tuy khdng kem theo vdng da tie mat. Kit qua eho thiy nhdm khdng ung thu tuy nhung vdng da t i e mdt ed ndng- dp trung binh CAI9-9 cQng khd eao: 564,48 U/ml.

Tuy nhien, gid tri nay vin thip han nong dd trung binh cua bdnh nhdn ung thu tyy vd sy khde bidt ndy Id cd )/ nghTa thong kd. Dliu ndy c6 nghTa ring, mdc dii tinh trang tie mdt ed Idm gia tang nong dd CA19-9 nhung vin du d i c6 thi phdn bidt giCra ung thu tuy vd khdng ung thu tuy.

Cd khd nhieu nghien eiru ve CA19-9/huylt thanh dd khing djnh sy khac bidt ed y nghTa giO-a bdnh nhdn ung thu tuy vd khdng phai ung thu- tuy. Dilu ddc bidt ddng luu y d t i t ea ede c6ng trinh nay Id dd biln thien eiia ning dd CA19-9 Id rit rdng. Nhu bang 2 da eho thiy, khoang biln thien eua nong dp CA19-9 tren nhO-ng bdnh nhdn ung thu tuy ciia nghidn cu-u ndy Id 1- 65400, nhung Douglas vd edng s'y [8]

cdn ndu ra mdt khoang biln thidn rdng han gip nhilu lin (7,3 - 2859640,0). Ddy se Id mdt hgn chl cho vide su- dung xdt nghidm ndy trong chin dodn bdnh. Ve gid trj chin dodn cua CA19-9: O l ddnh gid vai trd cua CAI 9-9

trong chan dodn ung thu tuy, ehu yiu se dua vdo dp nhay (Se) vd dd ddc hidu (Sp) ciia xet nghidm ndy. Qua khao sdt ede gid trj chin dodn nay vdi ede mii-e ngudng lya chpn khac nhau, ehiing tdi thiy mii-e ngudng 75U/ml Id phii hgp han ea eho vide chin dodn ung thu tuy vl d mii-e ndy se ed dp nhdy Id 70%, dd ddc hieu 68% vd ede gid tri tien dodn duang tfnh vd dm tfnh diu dat mii-e cao (74,6 vd 62,3%). Cy ngudng 37U/ml thi dd nhdy se cao han (76,3%) nhung dp dae hieu lai thip qud 55,3%.

So sdnh vdi nghidn eu-u eua nhiiu tdc gia khde, ehiing tdi thiy dd nhdy cua Id benh nhdn ung thu tuy trong nghidn eiru ndy Id thip han.

Ly do ed t h i la vi sd ngudi Viet Nam ed nhdm mdu Le(a-b-) cao (16,18%), gip 3 lin so vdi ngudi nude ngodi. Chfnh vi t h i sd ngudi ed xet nghiem dm tinh gia se eao vd din din dp nhdy se giam xudng.

Nhdn djnh v l vai trd chin dodn cua xet nghiem CA19-9 trong ung thu tuy, vdi nhirng kit qua thyc t l thu dugc qua nghien eiPU ndy, ehiing tdi eho ring ddy Id mdt xdt nghidm ed dp chfnh xde cap, rit ddng duge sir dyng nhu Id mdt bien phap phoi hgp trong nhieu bidn phdp chin dodn khde doi vdi ung thu tuy.

Cdc bidn phdp thdm dd chin dodn ung thu tuy khdng ngirng dugc hodn thidn vd ngdy edng ed thdm nhiiu ky thudt mdi hidn dai nhung eung khd ton kem vd phiPC tap v l mat ky thudt thyc hidn. Diiu nay khiln eho cdc thiy thuoc Idm sdng ddi khi gap khd khdn lung tiing trong vide lya chpn ede ky thudt phii hgp cho ngudi bdnh ciia minh. Trong so nhiiu bien phdp khde nhau, chyp elt Idp vi tinh hoae edng hudng tCr (MRI) td ra Id nhu-ng ky thudt chin dodn cd nhilu uu dilm doi vdi ede bdnh ly cua tuy nhung cung vin edn mdt diim ton tgi, dd Id khdng t h i phdn djnh duge tinh chit dc tinh hay Idnh tinh eiia ton thugng tuy. De khie phuc nhugc diim ndy, cd t h i phai kit hgp thdm nhieu bidn phdp khde nhu chpc sinh thilt dudi hudng din cua sieu dm hay CT nhung dd Id nh&ng bidn phdp thdm dd cd tfnh xdm hai vd

TCNCYH 74 (3)-2011 27

TAP CHI NGHIEN CU'U Y HOC'

phiPC tap. Thue t l trong qua trinh thue hien dd tdi ndy ehiing tdi thiy, nlu tren sieu dm hodc CT ed mdt khdi khu trii d tuy, nen chl djnh lam xdt nghidm CA19-9. Nlu kit qua xet nghiem nim trong khoang 37-100U/ml thi rit nghi ngd Id ung thu tuy. Nlu > 500U/ml thi chin dodn ung thu gin nhu ehle ehln.

Gid tri tien lugng vd theo ddi sau mo eua CA19-9: Khao sdt gid tri CAI 9-9 trude mo d nhdm ung thu tuy c i t duge u (n=16) vd nhdm khdng elt duge u (n=60), khdng thiy cd su khde biet ed y nghTa thong ke. Dieu ndy ed nghTa ring khdng t h i dya vao mii'e do CAI 9-9 trude mo d i tien dodn elt duge hay khdng elt duge u. Van Den Bosch [7] theo ddi mdt nhdm benh nhdn ung thu tuy, trong dd 21 benh nhdn elt duge u vd 15 benh nhan khdng elt duge u, thiy ndng dd CAI 9-9 trude mo eua nhdm elt duge u thip han nhung khdng ed y nghTa thong kd (p=0,9). Nhdn xet ndy eung duge ghi nhdn d nhiiu edng trinh nghidn eiru khac [9; 10]. Tuy nhien cung cd mdt vai nghien cii'u khing djnh vai trd tidn lugng eua CAI 9-9.

Cd 23 benh nhdn duge lam xet nghlein CAI 9-9 trude vd sau mo tai ede thdi dilm sau mo 2 tuin vd 4 tuin: 15 BN elt duge u (14 elt td-tuy, 1 elt thdn dudi tuy) vd 8 BN nil mat rudt. Kit qua eho thdy, d nhdm elt duge u, sau mo CAI 9-9 giam manh tip 90 - 93% so vdi mire trude mo (Bang 3). Sy giam nay Id ed y nghTa thdng ke (p<0,05). Trai lai sau mo khdng elt duge u, CAI 9-9 thay doi khdng ddng ke so vdi luc trudc mo. Tham ehf mdt sd edn ed xu hudng tang len. Nhu vdy ed the dya vdo mu-c dp thay doi nay eua CAI 9-9 d l ddnh gid chat lugng dilu tri ddi vdi ung thu tuy. Safi [9] edn di xa han: tde gia ndy da thiy sy giam ndng dp CAI9-9 sau mo elt u ed lidn quan d i n giai doan benh. 0 giai doan I vd II nlu phiu thudt Id triet d l (Ro) thi CAI 9-9 giam v l blnh thudng nhanh vd tilp tuc duy tri. Cf giai doan III vd IV nlu elt u khdng triet d l (Ri, R2) thi CAI 9-9 ed giam nhung khdng v i blnh thudng vd sau dd lai tilp tue tdng. Sd lugng benh nhdn theo ddi

sau mo cd thu' lai CAI 9-9 cua chung tdi trong nghien eiPu ndy cdn it nen chua t h i dua ra nhdn xet gi chic chin.

V. K^T LUAN

Nong dd CA19-9/huylt thanh cua BN UTTNT trung binh la 3609 ±10178 U/ml; dd nhdy 70%), dp dac hieu 68%, gid trj tidn dedn duang tfnh vd dm tfnh fan lugt d ede mire 74,6% vd 62,3%. Tren Idm sdng, mdt BN ed ede d i u hieu nghi ngd u tuy md tren sidu dm hay elt Idp vi tfnh khdng t h i xae djnh duge dd Id u Idnh hay u dc, nlu xdt nghidm CA19- 9/huylt thanh cho k i t qua > 500U/ml thi ehln dodn ung thu tuy g i n nhu chie ehln.

v l gid tri theo ddi tdi phat sau mo UTTNT eua CAI 9-9, eIn ed nhCrng nghien ciru vdf so lugng BN Idn han va thdi gian theo ddi sau mo dii ddj.

T A I

LIEU THAM

K H A O

1. Trdn Van Be (1998) He thong nhdm ABO-Lewls. Huyit hoc lam sang, 53-59.

2. Nguyin Viet Dung (2001). Old tri cua chdt chl diim khdi u CAI 9-9 trong chin doan vd tidn lugng sau mo ung thu tuy. Ludn van thac sy, Oai hpc Y Hd Ndi, 2001.

3. Hoang Van San (1996). Djnh lugng khang nguyen lien k i t ung thu CEA, CAI 9-9 vd CYFRA 21-1 trpng huylt thanh bdng ky thudt ELISA. Yhoc VietNam 34.

4. Boehringer Mannheim (1993).

Enzymum-Test system ES-33. Operation Short Guide.

5. Boehringer Mannheim (1986). Tumor markers: Their significance for the diagnosis and course of malignant tumor.

6. Koprowski H, Steplewski Z, Michell K, et al (1979) Colorectal carcinoma antigens detected by hybridoma antibodies. Somat Cell Genet. 5, 957-972.

7. Van den Bosch RP, van Eijek CHJ, Mulder PGH, Jeekel J (1996). Serum CAI9-9 determination in the management of

28 TCNCYH 74 (3)-2011

--- TAP CHl NGHIEN CLPU Y HQC pancreatic cancer. Hepato-Gastroenterology, 9. Safi F, Roscher R, Beger HG (1990).

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Summary

THE CLINICAL RELEVANCE OF THE TUMOR MARKER CA19-9 IN THE DIAGNOSING AND MONITORING OF PANCREATIC CANCER

To evaluate the role of tumor marker CAI 9-9 in diagnosing and monitoring of pancreatic cancer.

Patients and method: Descriptive study evaluating the role of tumor marker CAI 9-9 in the serum of suspected pamcreatie cancer patients through its sensitivity, specificity, positive and negative predictive value before operative (gold standard: adenoeareinome) and postoperative monitoring.

Results: 132 patients suspected from pancreatic cancer had been evaluated CAI 9-9 concentration in serum before operation and confirmed thereafter by pathological examination as if pancreatic cancer or not. 76 eases have been confirmed as pancreatic cancer and 56 eases as others. The mean value of CAI9-9 from serum san.ples pre-operation of 76 pancreatic cancer patients is 3609.1 ± 10178,6. If taking the cut-off value of CA19-9 as 75UI/ml, sensitivity (Se) would be 69.7%, specificity (Sp) 67.8% and the positive predictive value (PPV) 74.6%. The concentration of CAI9-9 decreased largely from 90-93% in comparison before and after pancreatic cancer resection (p<0.05). Conclusion: The mean concentration of CAI 9-9 beore operation in pancreatic cancer patients is rather high in comparing with normal value (3609U/ml). Detect the serum content of CAI9-9 in suspected pancreatic cancer patients is a useful measure for diagnosing pancreatic cancer before operation with sensitivity 70%, spaeifieity 68%. The role of postoperative monitoring for warning the cancer recurrence is not yet demonstrated by this study.

Keyword: CAI9-9, pancreatic cancer

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N H A N

LOAN DU'QNG CO DUCHENNE

Ta Thanh Van, Nguyin Thj Thanh Hai, Trdn Van Khanh Trudng Dai hoc Y Ha NQI

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