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±Ù·¡¿¡ ¼±Áø±¹À» Áß½ÉÀ¸·Î Áø´ÜºÐ¾ß´Â CTC(¼øȯÁ¾¾ç¼¼Æ÷), ctDNA(¼øȯ Á¾¾çDNA), Exosome(³ª³ë¼ÒÆ÷)À» ºÐ¸®ÇÏ¿© NGS À¯ÀüÀÚ ºÐ¼®À» ÇÏ¿© ´ë°³´Â ¾ÏÀÇ Àç¹ßÀ» Á¶±â¿¡ ã¾Æ³»°í ȯÀÚÀÇ ¸ÂÃã Ä¡·á¸¦ Á¦°øÇÏ´Â Precision Medicine(Á¤¹ÐÀÇÇÐ)À» ³»¼¼¿ö ¹ßÀüÇÏ°í ÀÖ½À´Ï´Ù.

ÀÌ ¾×ü»ý°Ë ¾ÏÁø´Ü ºÐ¾ß ±â¾÷Áß ´ëÇ¥ÀûÀΠȸ»ç°¡ Grail·Î¼­, MSÀÇ ºô °ÔÀÌÃ÷¿Í ¾Æ¸¶Á¸È¸»ç°¡ 1,000¾ïÀ» Ãʱ⿡ ÅõÀÚÇÏ°í µÚÀÌ¾î ´Ü¼û¿¡ 9.000¾ïÀ» ÅõÀÚ¹Þ¾Æ ¼¾¼¼À̼ÇÀ» ÀÏÀ¸Ä×Áö¿ä. ÀÌ Grailȸ»çÀÇ ±Ã±ØÀûÀÎ ¸ñÇ¥´Â °Ç°­Àο¡¼­ ¾ÏÀ» ½ºÅ©¸®´×ÇÏ´Â °ÍÀÔ´Ï´Ù. 

±×·±µ¥ °¨È÷ ±èö¿ì ´ëÇ¥´Â "¿ì¸®ÀÇ ±â¼úÀÌ Àû¾îµµ ÇâÈÄ 5³â°£Àº (¹«Áõ»ó)Á¤»óÀÎ ´ë»ó ¾Ï ½ºÅ©¸®´× ºÐ¾ß¿¡¼­ À̵麸´Ù ´õ È¿°úÀûÀ¸·Î ¼±µÎÀû À§Ä¡¿¡¼­ ´ëóÇØ ³ª°¥ ¼ö ÀÖ´Ù"°í °ú°¨È÷, ±×·¯³ª °â¼ÕÇÏ°Ô ÁÖÀåÇÕ´Ï´Ù. ±× ¹ß¾ðÀÇ ±Ù°Å¸¦ ´ÙÀ½°ú °°ÀÌ µé°í ÀÖ½À´Ï´Ù.

1> [Ãâ¹ß°ú ½Å³ä]

³ª¸§´ë·Î ¼³Á¤ÇÑ ¾î¶² ¸ñÇ¥¸¦ ÀÌ·ç±â À§Çؼ­´Â ÁÁÀº ÷´Ü ±â¼úÀÌ ½ÇÁ¦·Î µµ¿òÀº µÇÁö¸¸ ±× º¸´Ù Áß¿äÇÑ °ÍÀº ¾î¶»°Ô ÀÌ·ê °ÍÀÎÁö¿¡ ´ëÇÑ È®°íºÎµ¿ÇÑ Àü·«°ú ¸ñÇ¥ÀÇ ½Ç»óÀ» ²ç¶Õ¾îº¸´Â Çý¾È(Á÷°üÀû ½Å³ä.....¿Ö ±× ¸ñÇ¥¸¦ ¼¼¿ö ¸ðµç °Í ´õ ½ñ¾Æ¼­ Àü·ÂÅõ±¸ÇÏ¿© ÀÌ·ç°íÀÚ ÇÏ´ÂÁö¿¡ ´ëÇÑ Àý½ÇÇÑ Çʿ伺, °ð ±Ùº»Àû ÀÌÀ¯¿Í Àý´ëÀû °¡Ä¡....ÀÌ·Î ÀÎÇØ °áÄÚ µµÁß¿¡ Æ÷±âÇÒ ¼ö ¾ø°Ô ÇÔ)À̶ó°í »ý°¢ÇÕ´Ï´Ù.

(¹°·Ð Ʋ¸± ¼öµµ ÀÖ°ÚÀ¸³ª) ³ª¸§´ë·Î º¸°Çµ¥, Grail°ú ±× µ¿·ùÀÇ ¸¹Àº ȸ»çµéÀº ÀÏ´Ü ±â¼ú°ú ÀÚº»Àº Æ°Æ°ÇÏ°Ô °®Ãß¾ú´ÂÁö ¸ð¸£°ÚÁö¸¸ ½Ç»óÀ» ±íÀÌ Çì¾Æ·Á º¸´Â Çý¾ÈÀÌ ¾ÆÁ÷Àº ºÎÁ·ÇÑ °Í °°´Ù.. ÃßÃøÇØ º¼ ¼ö ÀÖ½À´Ï´Ù.  ¾Õ¼­ ¾ð±ÞÇÑ ´ëºÎºÐ ȸ»çÀÇ ½ÇÇè ´ë»ó ¹× ¿¬±¸´Â ºÐ¸íÈ÷ ½Ã·ù¿¡ µû¶ó ¾ÏȯÀڷκÎÅÍ ½ÃÀÛÇÏ°í Àֱ⠶§¹®¿¡, ¾Ï»ùÇÃÀÌ ¸¹À»¼ö·Ï ¹°·Ð ¼ö¸¹Àº ¾Ï»ùÇõéÀ» ´ë»óÀ¸·Î À¯ÀüÀÚ º¯À̸¦ ¸¹ÀÌ ÆľÇÇÒ ¼ö ÀÖÀ» °ÍÀÌ°í ±×µéÀÌ Ãß±¸ÇÏ´Â ¸ÂÃãÄ¡·áÀÇ ¿Ï¼ºµµ¸¦ ´õ ³ôÀÏ ¼ö´Â ÀÖ°ÚÁö¿ä.

¹ÙÀÎÀº Á¤»óÀεé°ú ¸¸¼ºÁúȯÀÚÀÇ Æ¯¼ºµé¿¡ ´ëÇØ Æ¯È÷ ±× µ¿¾È ¼ö½Ê³â°£ ÀÓ»ó¿¡¼­ È°¿ëÇÏ°í ÀÖ´Â ¸¶Ä¿µéÀ» Áß½ÉÀ¸·Î ÆľÇÇϴµ¥ ½Ê³â ÀÌ»óÀ» Àγ»Çϸç Áö¼ÓÀûÀ¸·Î ¿¬±¸ÇØ ¿Ô½À´Ï´Ù. ´Ù¸¥È¸»çµé°ú´Â ´Þ¸® ¿ÀÈ÷·Á Á¤¹Ý´ëÀÇ ¹æÇâ¿¡¼­ ¸ñÇ¥¸¦ ´Þ¼ºÇϱâÀ§ÇÑ ¾îÇÁ·ÎÄ¡¸¦ ÁøÇàÇÏ¿´°í Çö ½ÃÁ¡¿¡ À̸£·¯¼­ ¸¶Ä§³» ±× °á½ÇÀ» ¸Î¾î¿Â °ÍÀÔ´Ï´Ù.

¾ÏÀº ÀÏ»ýÀÇ ´©Àû±â°£À¸·Î´Â 3¸í Áß 1¸í¿¡¼­ ¹ß»ýÇÑ´ÙÁö¸¸  ´ë°³ÀÇ °æ¿ì ƯÁ¤ ½ÃÁ¡¿¡ µé¾î¼³ ¶§¿¡¾ß  ¹®Á¦°¡ µÇ´Â, ½Ç»óÀº ¾îÂ¸é ¸Å¿ì rareÇÑ Áúº´ÀÌÁö¿ä. Áï, Á¤»óÀÎÀÇ ´Ù¾çÇÑ Æ¯¼ºµéÀ» Àß ºÐ¼®ÇÒ ¼ö ÀÖ¾î¾ß¸¸ ±× °¡¿îµ¥¼­ ¾Ï À§Ç豺À» ã¾Æ³¾ ¼ö ÀÖ½À´Ï´Ù. (ºÐ¸íÈ÷ ctDNA, NGS ºÐ¸íÈ÷ ¸ðµÎ ȯ»óÀûÀÎ ±â¼úµéÀÔ´Ï´Ù¸¸ ±¹³» ÀÌ ºÐ¾ß¿¡¼­ ¸Å¿ì È°¹ßÇÏ°Ô ¿¬±¸ °³¹ß¿¡ ÁýÁßÇÏ°í ÀÖ´Â ±â¼úÃ¥ÀÓÀÚ°¡ ¼ÖÁ÷ÇÏ°Ô °í¹éÇÏ´Â ¹Ù´Â Åë°èºÐ¼® °á°ú°¡ ¶§¶§·Î ¸Å¿ì ¾Ö¸ÅÇÒ ¶§¿¡´Â ´Ü¹é ¾ÏÇ¥ÁöÀÚ °Ë»ç¸¦ °¡²û ½ÃÇàÇØ º¸´Âµ¥, ¸Å¿ì ºÐ¸íÇÑ °á°ú¸¦ Á¦°øÇØ Áֱ⶧¹®¿¡ µµ¿òÀÌ ¸¹ÀÌ µÈ´Ù°í ÇÕ´Ï´Ù.)

2>[¹Ì¸® ³»´Ùº¸´Â ÁøÃëÀû ¸¶ÀÎµå ¿©ºÎ]

 2002³â ¹ÙÀÎÀº BT+IT À¶ÇÕȸ»ç¸¦ ³»¼¼¿ö ´ÙÁöÇ¥ºÐ¼® ¹× ¾Ë°í¸®Áò °³¹ßÀ» À§ÇØ ¿¬±¸°³¹ßÀ» ½ÃÀÛÇÏ¿´°í 2011³â ½º¸¶Æ®¾Ï°Ë»ç prototypeÀ» ¿Ï¼ºÇÏ¿´½À´Ï´Ù. ºòµ¥ÀÌÅͶõ ´Ü¾î´Â 2013³â¿¡ »ç¿ëµÇ±â ½ÃÀÛÇÏ¿´°í 2015³â ¾ËÆÄ°í°¡ À̼¼µ¹À» °ÝÆÄÇϸ鼭 AI´Â ¿ÏÀüÈ÷ ½Å±â¼ú·Î ÀÚ¸®¸Å±èÇϱ⠽ÃÀÛÇÏ¿´½À´Ï´Ù. ¹ÙÀÎÀÌ  prototypeÀ» ¼­ºñ½º¸¦ ½ÃÀÛÇÒ¶§¿¡ ÀÇ·áÀü¹®°¡µéÀº ¾Ï¸¶Ä¿°Ë»ç¿¡¼­ ±× ¼ýÀÚ¸¦ ¿©·¯°³·Î ´Ã¸°°Ô ¹«½¼ ½Å±â¼úÀ̳İí ÇÏ¿´½À´Ï´Ù.

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ÀÌ´Â ·Ôµ¥ °è¿­»çµé ÀÓÁ÷¿ø »Ó¸¸¾Æ´Ï¶ó ¸ðµç »ç¾÷üÀÇ °í°´È¸¿øµéÀÌ ´ë»óÀ̸ç Wellness software¿¡¼­ °Ç°­ Àû½ÅÈ£°¡ ³ª¿À¸é ¹Ù·Î I-Finder Ãß°¡°Ë»ç ¿¬°áÀü·«À¸·Î ÃßÁøµË´Ï´Ù. ÀÌ´Â ²À º´ÀÇ¿øÀ̳ª ±âÁ¸ ¸¶ÄÉÆà ä³ÎÀ» ÅëÇÏÁö ¾Ê°íµµ ÀÚ¿¬½º·´°Ô I-Finder¸¦ °í°´ÀÌ Á¢ÇÒ ¼ö ÀÖ°Ô µÇ´Â »õ·Î¿î °Ç°­ Àü´Þ½Ã½ºÅÛÀÌ ±¸ÃàÀÌ µÇ´Â ¼ÀÀÔ´Ï´Ù.

‘»þ·Ôµ¥’ Ç÷§ÆûÀº ÀÌ¹Ì ·Ôµ¥Á¤º¸Åë½Å¿¡¼­ ±¸ÃàÇÏ°í ÀÖ´Â º£Æ®³² ÃÖ´ë º´¿ø ½Ã½ºÅÛ¿¡¼­µµ ±¸µ¿µÉ ¿¹Á¤À¸·Î ÀúÈñ »ç¾÷ÀÌ º£Æ®³²¿¡ ¾ÈÂøÇÒ ¼ö ÀÖ´Â ÁÁÀº ±âȸÀ̱⵵ ÇÕ´Ï´Ù.

ÀúÈñ´Â Àηù¸¦ ‘°Ç°­±×·ì - wellness care ±×·ì - sickness care ±×·ì – cancer care ±×·ì’À¸·Î ±¸ºÐÇÏ¿© °¢ ±×·ì¿¡ ¸Â´Â À§Ç豺 ºÐ·ù ¼Ö·ç¼ÇÀ» °³¹ßÇÏ¿© Á¦°øÇÏ°íÀÚ ÇÕ´Ï´Ù.

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°£¼¼Æ÷¾ÏÁ¾ Á¶±âÁø´ÜÀÇ Á¾¾çÇ¥ÁöÀÚ Biomarkers in screening and surveillance of HCC

ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ³»°úÇб³½Ç ä Èñ º¹ 2010³â ´ëÇÑ°£ÇÐȸ Single Topic Symposium

20. Carr BI, Kanke F, Wise M, Satomura S. Clinical evaluation of lens culinaris agglutinin-reactive alpha-fetoprotein and des-gamma-carboxy prothrombin in histologically proven hepatocellular carcinoma in the United States. Dig Dis Sci 2007;52:776-782.

21. Sterling RK, Jeffers L, Gordon F, Venook AP, Reddy KR, Satomura S, et al. Utility of Lens culinaris agglutinin-reactive fraction of alphafetoprotein and des-gamma-carboxy prothrombin, alone or in combination, as biomarkers for hepatocellular carcinoma. Clin Gastroenterol Hepatol 2009;7:104-113.

22. Sterling RK, Jeffers L, Gordon F, Sherman M, Venook AP, Reddy KR, et al. Clinical utility of AFP-L3% measurement in North American patients with HCV-related cirrhosis. Am J Gastroenterol 2007;102:2196-2205.

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***World J Gastroenterol. 2013 Jan 21;19(3):339-46. doi: 10.3748/wjg.v19.i3.339.
Diagnostic value of AFP-L3 and PIVKA-II in hepatocellular carcinoma according to total-AFP. Choi JY1, Jung SW, Kim HY, Kim M, Kim Y, Kim DG, Oh EJ.
Abstract AIM:
To evaluate diagnostic value of α-fetoprotein (AFP)-L3 and prothrombin induced by vitamin K absence-II (PIVKA-II) in hepatocellular carcinoma (HCC).

METHODS:
One hundred and sixty-eight patients during routine HCC surveillance were included in this study. Of the 168 patients, 90 (53.6%) had HCC including newly developed HCC (n = 82) or recurrent HCC after treatment (n = 8). Sera were obtained during their first evaluation for HCC development and at the time of HCC diagnosis before commencing HCC treatment. HCC was diagnosed by histological examination, appropriate imaging characteristics-computed tomography or magnetic resonance imaging. Control sera were collected from 78 patients with benign liver disease (BLD), which were obtained during routine surveillance with a suspicion of HCC. AFP, AFP-L3 and PIVKA-II were measured in the same serum by microchip capillary electrophoresis and liquid-phase binding assay on a micro-total analysis system Wako i30 auto analyzer. The performance characteristics of three tests and combined tests for the diagnosis of HCC were obtained using receiver operating characteristic curves in all populations and subgroups with AFP < 20 ng/mL.
RESULTS:
Of 90 HCC patients, 38 (42.2%) patients had AFP < 20 ng/mL, 20 (22.2%) patients had AFP 20-200 ng/mL and 32 (35.6%) patients had AFP > 200 ng/mL. Of the 78 BLD patients, 74 (94.9%) patients had AFP < 20 ng/mL. After adjustment for age and HBV infection status, AFP-L3 levels were higher in HCC than in BLD among patients with low AFP levels (< 20 ng/mL) (P < 0.001). In a total of 168 patients, areas under the curve (AUC) for HCC were 0.879, 0.887, 0.801 and 0.939 for AFP, AFP-L3, PIVKA-II and the combined markers, respectively. The combined AUC for three markers showed higher value than the AUCs of individual marker (P < 0.05). AFP-L3 had higher AUC value than PIVKA-II for HCC detection in entire patients (P = 0.043). With combination of AFP-L3 (cut-off > 5%) and PIVKA-II (cut-off > 40 AU/L), the sensitivity were 94.4% and specificity were 75.6% in all patients. In 112 patients with low AFP levels (< 20 ng/mL), AUCs of AFP-L3, PIVKA-II and combine AFP-L3 and PIVKA-II tests were 0.824, 0.774 and 0.939, respectively. AFP-L3 with a cut-off value of 5% showed sensitivity of 71.1% and specificity of 83.8%, and PIVKA-II with a cut-off value of 40 AU/L had sensitivity of 57.9% and specificity of 95.9% in patients with low AFP levels. The combination of AFP-L3 and PIVKA-II increased the sensitivity and specificity up to 92.1% and 79.7%, respectively, in low AFP group. Combined markers detected 81.8% of early stage HCC (Union for International Cancer Control stage I), 86.7% of small sized tumor (< 2 cm) and 91.7% of single tumor of HCC in the low AFP group. In multivariate analysis, AFP-L3 was correlated with AFP and tumor size, and PIVKA-II was correlated with laboratory tests including serum aspartate aminotransferase, total bilirubin, platelets and albumin levels. PIVKA-II had no correlation with AFP, AFP-L3 or tumor characteristics.
CONCLUSION:
Combined determination of AFP-L3 and PIVKA-II could improve the diagnostic value for HCC detection in patients with or without increased AFP levels.
-----------------------------------------
With combination of AFP-L3 (cut-off > 5%) and PIVKA-II (cut-off > 40 AU/L), the sensitivity were 94.4% and specificity were 75.6% in all patients. In 112 patients with low AFP levels (< 20 ng/mL), AUCs of AFP-L3, PIVKA-II and combine AFP-L3 and PIVKA-II tests were 0.824, 0.774 and 0.939, respectively
´ÙÀ½±Û : ½æ4 CancerSEEK Phar East
ÀÌÀü±Û : ½æ2 ÃÖ÷´ÜºÐÀÚÁø´Ü.°¡Ä¡°è»ê