onkoreferat ppt.ppt
TRANSCRIPT
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MARKER PROTEIN SERUM UNTUK
DETEKSI KANKER OVARIUM
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PENDAHULUAN
Ca ovariumkematian kanker ginekologi dan
kematian terbanyak akibat kanker pada wanita
Eropa dan AS
Diagnosis dini epithelial ovarian cancer (EOC)
secara signifikan morbiditas dan mortalitas
Biomarker potensial dx ca ovarium tp sedikit yg
dapat mendeteksi sebagai skrining stadium awal
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DETEKSI DINI CA OVARIUM
Mayoritas (85-95%) tumor ovarium malignan di
Amerika tipe epitelial
Metode deteksi dini imunologi ca ovarium pmxantigen yg berhubungan dg tumor, CA-125
CA-125 meningkat pd
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Serum Protein Marker untuk Deteksi Dini
Ca Ovarium
Analisis sampel serum dg spektrometri mencari
protein atau fragmen protein mendeteksi
keberadaan atau tidak adanya kanker
Alnalisis ada tidaknya suatu protein atau peptida
dlm serum antibodi ELISA atau pendekatan lain
sebagai kombinasi biomarker dg peningkatan
spesifitas dan sensitivitas CA-125 terhadap ca
ovarium
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Populasi Pasien
Sampel serum 86 orang, 28 sehat dan bebas
penyakit, 18 dx EOC stadium III/IV dan 40pasien dg EOC rekuren III/IV
+ adisional cohort dari 40 individu (8 sehat, 32
pasien EOC, std I-II) validasi blind set marker
Material dan metode
10 ml darah disentrifugal 800x 10 mnt serum
akan terseparasi, disimpan -80C Bank jaringanOB/GYN Yale University School of Medicine
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HASIL
Total 169 protein dianalisis Cytokin Rolling CircleAmplification (RCA) Microarrays, ELISA dan analisisstatistik.
35 protein--markerkelompok sehat dan pasien EOCberdasarkan tes ANOVA dengan nilai P
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Fig. 1.Four tumor markers identified for which the RCA microarray data and ELISA
data were completely concordant in classifying serum from normal and EOC
individuals in the training cohort. Microarray data are expressed as median
fluorescence intensity (mfl); ELISA data are expressed as average protein
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Tabel Split Poin
Marker Split point Left interval Right interval
Leptin 2.5 Cancer (1) Normal (0)
Prolactin 10 Normal (0) Cancer (1)
OPN 21 Normal (0) Cancer (1)
IGF-II 491 Cancer (1) Normal (0)
The split-point scoring procedure is as follows. For each marker, find the best split point to
minimize the number of misclassified individuals. The split point divides the sample spaceinto two intervals: one for normal and another for cancer. A score of 0 is assigned to anindividual if the related analyte value falls in the normal interval; otherwise, a score of 1 isassigned. Overall, an individual is assigned a score as the sum of the assigned scoresfrom four different markers, the range of such scores being 0-4.
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40 sampel -- analisis klasifikasi split poin
Hasil 37 dari 40 sampel tepat diidentifikasi (94%)
Fig. 3.Four-analyte split-point analysis of serum from healthy women (Healthy) and womenwith EOC (Cancer). Correctly classified normal serum should have a score of 0 or 1, whereassamples from cancer patients have a score of 2, 3, or 4. False-positive and false-negativesamples are readily detected.
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DISKUSI
Ca ovarium relatif asimtomatik -- monitoring dan deteksidini yang tepat
Tes harus dapat mendeteksi secara akurat perubahan
dari pre malignan atau ca ovarium std dini asimtomatik --- ca ovarium
Analisis 4 biomarker hasil skrining signifikan
+ Ca 125 atau protein lain mengimplikasi diskriminasi
EOC mempertegas sensitivitas/spesifitas tes tsb
Skrining diperlukan juga pemeriksaan tambahan sepertiUSG transvaginal
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SIMPULAN
Marker diskriminasi ca ovarium dan normaldilaporkan disini mungkin bukan merupakanmarker spesifik untuk EOC
Set protein akurasi tinggi dapat membedakanantara pasien EOC dan normal (std I dan II)
Uji serum empat protein markersensitivitas 95%, spesifitas 95%, PPV 95%,dan nilai prediktif negatif 94% .