Luận án Biểu hiện PD-L1, đặc điểm lâm sàng và giải phẫu bệnh trong đáp ứng xạ trị và tiên lượng ung thư hốc miệng

Nghiên cứu của chúng tôi lấy mẫu người bệnh đến khám và điều trị tại Bệnh viện Ung Bướu Thành phố Hồ Chí Minh trong khoảng thời gian năm 2016 và 2017. Đây là khoảng thời gian chuyển tiếp trong việc triển khai phân loại mới của AJCC 7 và 8 tại bệnh viện. Thiết kế nghiên cứu đoàn hệ theo dõi các kết quả của quá trình điều trị cũng như các đặc điểm sinh học của bướu nguyên phát. Vì vậy chúng tôi chọn dùng một phân loại AJCC 7 để có đủ thông tin cũng như thống nhất trong nghiên cứu. Có một số nghiên cứu đoàn hệ theo dõi dài cũng đã thử phân loại theo phiên bản thứ 7 trong giai đoạn đầu và phiên bản thứ 8 trong gian đoạn sau.107,144 Tuy nhiên đa số các nghiên cứu này cũng như nghiên cứu của chúng tôi là các nghiên cứu hồi cứu. Vì vậy một số thông tin có thể sẽ không thu thập thêm được nếu muốn phân giai đoạn theo phiên bản mới. Mặc dù AJCC 8 được đánh giá là có ưu điểm hơn trong tiên lượng so với AJCC 7, tuy nhiên việc xác định độ sâu xâm lấn (DOI) hay xâm lấn vỏ bao hạch (ENE) vẫn là một vấn đề khó khăn và thách thức, không phải luôn được thực hiện do mẫu mô bệnh phẩm không đạt chuẩn về vị trí và độ sâu, nhất là trong trường hợp mẫu mô là từ sinh thiết chẩn đoán. Vì vậy, phân loại theo phiên bản thứ 8 không phải luôn thực hiện được một cách chính xác. Mặt khác, phân loại theo AJCC 8 đưa thêm vào các yếu tố mô học do đó, cần có kết quả sau phẫu thuật mà thực tế, UTHM có thể không phải luôn luôn chỉ định hoặc lựa chọn phẫu thuật. Vì vậy, không phải luôn có thể phân giai đoạn theo phiên bản thứ 8. Để nỗ lực phân giai đoạn theo phiên bản mới nhưng không phẫu thuật, một số công cụ chẩn đoán hình ảnh như chụp cắt lớp CT-Scan, MRI hoặc siêu âm để xác định DOI hoặc ENE đại thể. Tuy vậy độ nhạy và độ chuyên biệt của các phương tiện chẩn đoán này vẫn còn tranh cãi.148 DOI không thể tính cho các ca sinh thiết chẩn đoán được. Tương tự như vậy ENE cũng chỉ đánh giá được cho các ca có phẫu thuật và nạo hạch. Đánh giá theo AJCC 7 phù hợp cho giai đoạn chẩn đoán ban đầu, lập kế hoạch điều trị. AJCC 8 phù hợp để lên kế hoạch tiếp theo trong hoặc sau phẫu thuật.

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