xov xwm

Nyob rau hauv kaum xyoo dhau los, gene sequencing thev naus laus zis tau siv dav hauv kev tshawb fawb txog mob qog noj ntshav thiab kev kho mob, dhau los ua cov cuab yeej tseem ceeb los qhia cov yam ntxwv ntawm cov qog nqaij hlav cancer. Kev nce qib hauv kev kuaj mob molecular thiab cov phiaj xwm kev kho mob tau txhawb txoj kev txhim kho ntawm cov qog nqaij hlav precision kho cov ntsiab lus thiab coj cov kev hloov pauv zoo rau tag nrho cov kab mob qog thiab kev kho mob. Kev ntsuam xyuas caj ces tuaj yeem siv los ceeb toom txog kev pheej hmoo mob qog noj ntshav, qhia kev txiav txim siab kho mob thiab ntsuas kev ntsuas, thiab yog ib qho tseem ceeb los txhim kho cov txiaj ntsig ntawm cov neeg mob. Ntawm no, peb sau cov ntsiab lus tsis ntev los no luam tawm hauv CA Cancer J Clin, JCO, Ann Oncol thiab lwm cov ntawv xov xwm los tshuaj xyuas cov ntawv thov kev kuaj caj ces hauv kev kuaj mob qog noj ntshav thiab kev kho mob.

Somatic mutations thiab germline mutations. Feem ntau, mob qog noj ntshav yog tshwm sim los ntawm DNA kev hloov pauv uas tuaj yeem tau txais los ntawm cov niam txiv (germline mutations) lossis tau muaj hnub nyoog (somatic mutations). Kab mob kab hloov pauv tau tshwm sim los ntawm kev yug me nyuam, thiab tus mutator feem ntau nqa qhov kev hloov pauv hauv DNA ntawm txhua lub cell hauv lub cev thiab tuaj yeem xa mus rau cov xeeb ntxwv. Somatic kev hloov pauv tau txais los ntawm cov tib neeg hauv cov hlwb uas tsis yog gametic thiab feem ntau tsis kis mus rau cov xeeb ntxwv. Ob leeg germline thiab somatic kev hloov pauv tuaj yeem rhuav tshem cov haujlwm ua haujlwm ntawm cov hlwb thiab ua rau muaj kev hloov pauv ntawm cov hlwb. Somatic kev hloov pauv yog tus tsav tsheb tseem ceeb ntawm kev mob qog noj ntshav thiab kev kwv yees biomarker tshaj plaws hauv oncology; Txawm li cas los xij, kwv yees li 10 mus rau 20 feem pua ​​​​ntawm cov neeg mob qog muaj cov kab mob hloov pauv uas ua rau muaj kev pheej hmoo mob qog noj ntshav, thiab qee qhov kev hloov pauv no kuj kho tau.
Kev hloov pauv ntawm tus neeg tsav tsheb thiab cov neeg caij tsheb sib hloov. Tsis yog txhua qhov DNA hloov pauv cuam tshuam rau kev ua haujlwm ntawm tes; Qhov nruab nrab, nws yuav siv tsib mus rau kaum qhov xwm txheej genomic, hu ua "tsav kev hloov pauv," kom ua rau lub cev tsis zoo. Cov kev hloov pauv ntawm cov neeg tsav tsheb feem ntau tshwm sim hauv cov noob uas cuam tshuam nrog cov haujlwm hauv lub neej, xws li cov noob koom nrog hauv kev tswj hwm kev loj hlob ntawm tes, kho DNA, tswj lub voj voog ntawm tes thiab lwm yam txheej txheem hauv lub neej, thiab muaj peev xwm siv los ua cov hom phiaj kho mob. Txawm li cas los xij, tag nrho cov kev hloov pauv hauv ib qho mob qog noj ntshav yog qhov loj heev, txij li ob peb txhiab hauv qee cov qog nqaij hlav mis mus rau ntau dua 100,000 hauv qee cov qog nqaij hlav hauv plab thiab endometrial. Feem ntau cov kev hloov pauv tsis muaj lossis txwv qhov tseem ceeb ntawm kev lom neeg, txawm tias kev hloov pauv tshwm sim hauv cheeb tsam coding, xws li kev hloov pauv tsis tseem ceeb yog hu ua "kev hloov pauv neeg caij tsheb". Yog hais tias ib tug gene variant nyob rau hauv ib hom qog nqaij hlav kwv yees nws cov lus teb rau los yog tsis kam mus rau kev kho mob, qhov txawv yog suav hais tias kho mob ua hauj lwm.
Oncogenes thiab qog suppressor noob. Cov noob uas nquag hloov pauv hauv kev mob qog noj ntshav tuaj yeem faib ua ob pawg, oncogenes thiab qog nqaij hlav qog. Nyob rau hauv ib txwm cov hlwb, cov protein encoded los ntawm oncogenes feem ntau plays lub luag hauj lwm ntawm kev txhawb cell proliferation thiab inhibiting cell apoptosis, thaum lub protein encoded los ntawm oncosuppressor noob yog lub luag hauj lwm rau tsis zoo regulating cell division kom tswj lub cev muaj nuj nqi. Hauv cov txheej txheem hloov pauv tsis zoo, kev hloov pauv genomic ua rau kev txhim kho ntawm oncogene kev ua haujlwm thiab txo qis lossis poob ntawm oncosuppressor noob kev ua haujlwm.
Kev hloov pauv me me thiab cov qauv sib txawv. Cov no yog ob hom kev hloov pauv tseem ceeb hauv genome. Cov kev hloov pauv me me hloov DNA los ntawm kev hloov pauv, tshem tawm, lossis ntxiv cov hauv paus me me, suav nrog cov hauv paus ntxig, tshem tawm, hloov pauv, pib codon poob, nres codon poob kev hloov pauv, thiab lwm yam. Cov qauv kev hloov pauv yog qhov loj ntawm cov genome rearrangement, suav nrog cov gene segments xws li qhov loj los ntawm ob peb txhiab lub hauv paus rau feem ntau ntawm cov kev hloov pauv, suav nrog ntau tus lej chromosome. deletion, duplication, inversion lossis translocation. Cov kev hloov pauv no tuaj yeem ua rau txo qis lossis txhim kho cov haujlwm ntawm cov protein. Ntxiv rau qhov kev hloov pauv ntawm qib ntawm cov noob caj noob ces, genomic kos npe kuj yog ib feem ntawm cov ntaub ntawv qhia txog kev soj ntsuam. Genomic kos npe tuaj yeem pom raws li cov qauv sib txawv ntawm cov qauv me me thiab / lossis cov qauv sib txawv, suav nrog cov qog mutation load (TMB), microsatellite instability (MSI), thiab homologous recombination defects.

Clonal mutation thiab subclonal mutation. Clonal mutations muaj nyob rau hauv tag nrho cov qog hlwb, muaj nyob rau ntawm kev kuaj mob, thiab nyob twj ywm tam sim no tom qab kev kho mob ua ntej. Yog li ntawd, clonal mutations muaj peev xwm siv tau raws li cov hom phiaj kho mob. Subclonal mutations muaj nyob rau hauv tsuas yog ib feem ntawm cov qog nqaij hlav cancer thiab tej zaum yuav raug kuaj pom thaum pib ntawm kev kuaj mob, tab sis ploj mus tom qab rov tshwm sim los yog tshwm sim tom qab kho. Cancer heterogeneity yog hais txog qhov muaj ntau yam kev hloov pauv hauv subclonal hauv ib leeg. Qhov tseem ceeb, feem ntau ntawm kev kho mob tseem ceeb ntawm kev hloov pauv hauv txhua hom mob qog noj ntshav yog clonal mutations thiab nyob ruaj khov nyob rau hauv kev mob qog noj ntshav. Kev tawm tsam, uas feem ntau kho los ntawm subclones, yuav tsis raug kuaj pom thaum lub sijhawm kuaj mob tab sis tshwm sim thaum nws rov qab los tom qab kho.

Cov txheej txheem ib txwm siv FISH lossis cell karyotype yog siv los txheeb xyuas cov kev hloov pauv ntawm qib chromosomal. FISH tuaj yeem siv los txheeb xyuas cov noob fusions, kev tshem tawm, thiab kev nthuav dav, thiab suav tias yog "tus qauv kub" rau kev txheeb xyuas cov kev hloov no, nrog cov neeg siab thiab rhiab heev tab sis muaj kev txwv. Hauv qee qhov hematologic malignancies, tshwj xeeb tshaj yog mob leukemia, karyotyping tseem siv los qhia kev kuaj mob thiab kev kuaj mob, tab sis cov txheej txheem no tau maj mam hloov los ntawm cov phiaj xwm ntsuas molecular xws li FISH, WGS, thiab NGS.
Cov kev hloov pauv hauv cov noob caj noob ces tuaj yeem kuaj pom los ntawm PCR, ob qho tib si PCR ntawm lub sijhawm thiab digital poob PCR. Cov txheej txheem no muaj qhov rhiab heev, tshwj xeeb tshaj yog tsim nyog rau kev tshawb nrhiav thiab saib xyuas cov kab mob me me, thiab tuaj yeem tau txais cov txiaj ntsig hauv lub sijhawm luv luv, qhov tsis zoo yog qhov kev tshawb nrhiav ntau yam txwv (feem ntau tsuas yog kuaj pom kev hloov pauv hauv ib lossis ob peb lub noob), thiab muaj peev xwm rau ntau yam kev sim yog txwv.
Immunohistochemistry (IHC) yog cov cuab yeej saib xyuas cov protein uas feem ntau siv los txheeb xyuas qhov kev qhia ntawm biomarkers xws li ERBB2 (HER2) thiab estrogen receptors. IHC kuj tuaj yeem siv los txheeb xyuas cov proteins tshwj xeeb (xws li BRAF V600E) thiab cov noob fusions tshwj xeeb (xws li ALK fusions). Qhov zoo ntawm IHC yog tias nws tuaj yeem yooj yim sib xyaw rau hauv cov txheej txheem tshuaj xyuas cov ntaub so ntswg niaj hnub, yog li nws tuaj yeem ua ke nrog lwm yam kev sim. Tsis tas li ntawd, IHC tuaj yeem muab cov ntaub ntawv ntawm subcellular protein localization. Qhov tsis zoo yog qhov txwv tsis pub muaj peev xwm thiab cov koom haum xav tau siab.
Second-generation sequencing (NGS) NGS siv high-throughput parallel sequencing techniques to detect variations at DNA and/or RNA level. Cov txheej txheem no tuaj yeem siv los ua kom tiav tag nrho cov genome (WGS) thiab cov gene thaj tsam ntawm kev txaus siab. WGS muab cov ntaub ntawv qhia txog kev hloov pauv genomic tshaj plaws, tab sis muaj ntau yam teeb meem rau nws daim ntawv thov kev kho mob, suav nrog kev xav tau cov qog nqaij hlav tshiab (WGS tseem tsis tau tsim nyog rau kev tshuaj xyuas cov qauv formalin-immobilized) thiab tus nqi siab.
Targeted NGS sequencing suav nrog tag nrho exon sequencing thiab phiaj gene vaj huam sib luag. Cov kev ntsuam xyuas no txhawb cov cheeb tsam ntawm kev txaus siab los ntawm DNA sojntsuam lossis PCR amplification, yog li txwv tus nqi sequencing uas yuav tsum tau (tag nrho exome ua 1 mus rau 2 feem pua ​​​​ntawm cov genome, thiab txawm tias loj panels uas muaj 500 genes tsuas yog 0.1 feem pua ​​ntawm cov genome). Txawm hais tias tag nrho exon sequencing ua tau zoo hauv cov ntaub so ntswg formalin, nws cov nqi tseem siab. Lub hom phiaj ntawm kev sib txuas ntawm noob caj noob ces yog kev lag luam thiab tso cai rau kev hloov pauv ntawm cov noob los sim. Tsis tas li ntawd, circulating dawb DNA (cfDNA) yog qhov kev xaiv tshiab rau kev tshuaj ntsuam genomic ntawm cov neeg mob qog noj ntshav, hu ua kua biopsies. Ob lub hlwb qog nqaij hlav thiab cov hlwb ib txwm tuaj yeem tso DNA rau hauv cov hlab ntsha, thiab DNA tso tawm los ntawm cov qog nqaij hlav qog nqaij hlav hu ua circulating qog DNA (ctDNA), uas tuaj yeem txheeb xyuas kom pom cov kev hloov pauv hauv cov qog hlwb.
Qhov kev xaiv ntawm kev xeem yog nyob ntawm seb qhov teeb meem tshwj xeeb yuav tsum tau daws. Feem ntau ntawm biomarkers cuam tshuam nrog kev pom zoo kho tuaj yeem kuaj pom los ntawm FISH, IHC, thiab PCR cov txheej txheem. Cov txheej txheem no tsim nyog rau kev tshawb pom ntawm cov khoom me me ntawm biomarkers, tab sis lawv tsis txhim kho cov txiaj ntsig ntawm kev tshawb pom nrog kev nce ntxiv, thiab yog tias kuaj pom ntau biomarkers, tej zaum yuav tsis muaj cov ntaub so ntswg txaus rau kev tshawb nrhiav. Hauv qee cov qog nqaij hlav tshwj xeeb, xws li mob ntsws cancer, qhov twg cov qauv ntaub so ntswg nyuaj kom tau txais thiab muaj ntau yam biomarkers los kuaj, siv NGS yog qhov kev xaiv zoo dua. Hauv kev xaus, qhov kev xaiv ntawm kev ntsuam xyuas nyob ntawm seb muaj pes tsawg tus biomarkers yuav raug kuaj rau txhua tus neeg mob thiab tus naj npawb ntawm cov neeg mob yuav tsum tau kuaj rau biomarker. Qee qhov xwm txheej, kev siv IHC / FISH txaus, tshwj xeeb tshaj yog thaum lub hom phiaj tau txheeb pom, xws li kuaj pom cov tshuaj estrogen receptors, progesterone receptors, thiab ERBB2 hauv cov neeg mob qog noj ntshav. Yog tias muaj kev tshawb nrhiav ntau dua ntawm kev hloov pauv ntawm cov genomic thiab kev tshawb nrhiav cov hom phiaj kho mob uas yuav tsum tau ua, NGS muaj kev txhim kho ntau dua thiab raug nqi. Tsis tas li ntawd, NGS yuav raug txiav txim siab nyob rau hauv rooj plaub uas IHC/FISH cov txiaj ntsig tsis meej lossis tsis meej..

Cov txheej txheem sib txawv muab cov lus qhia uas cov neeg mob yuav tsum tsim nyog rau kev kuaj caj ces. Xyoo 2020, ESMO Precision Tshuaj Ua Haujlwm Pab Pawg tau tshaj tawm thawj NGS cov lus pom zoo rau cov neeg mob qog noj ntshav siab, pom zoo niaj hnub NGS kuaj rau cov mob qog noj ntshav tsis zoo uas tsis yog me me hauv lub ntsws, mob qog noj ntshav, mob qog nqaij hlav, mob qog noj ntshav, mob qog noj ntshav, thiab qog nqaij hlav qog nqaij hlav ntawm zes qe menyuam, thiab xyoo 2024, cov qog nqaij hlav qog nqaij hlav tsis tshua muaj. Xws li cov qog nqaij hlav hauv plab, sarcomas, cov qog nqaij hlav qog nqaij hlav thiab cov qog nqaij hlav tsis paub keeb kwm.
Hauv xyoo 2022, ASCO's Clinical Opinion on somatic genome testing in the patient with metastatic or advanced cancer states that if a biomarker related therapy are pomed in patient with metastatic or advanced solid cancers, genetic test is recommend for these patient. Piv txwv li, kev kuaj genomic yuav tsum tau ua nyob rau hauv cov neeg mob uas muaj metastatic melanoma los tshuaj ntsuam rau BRAF V600E kev hloov pauv, raws li RAF thiab MEK inhibitors tau pom zoo rau qhov kev qhia no. Tsis tas li ntawd, kev ntsuam xyuas caj ces yuav tsum tau ua yog tias muaj qhov pom tseeb ntawm kev tiv thaiv rau cov tshuaj yuav tsum tau muab rau tus neeg mob. Egfrmab, piv txwv li, tsis muaj txiaj ntsig hauv KRAS mutant mob qog noj ntshav. Thaum txiav txim siab txog tus neeg mob qhov tsim nyog rau kev sib txuas ntawm cov noob, tus neeg mob lub cev, kev tsis sib haum xeeb, thiab cov qog qog yuav tsum tau ua ke, vim hais tias cov kauj ruam yuav tsum tau ua rau genome sequencing, suav nrog tus neeg mob kev pom zoo, kev sim ua, thiab kev txheeb xyuas cov txiaj ntsig sib luag, xav kom tus neeg mob muaj lub cev muaj peev xwm thiab lub neej ntev.
Ntxiv nrog rau kev hloov pauv ntawm somatic, qee cov qog nqaij hlav yuav tsum tau kuaj xyuas cov noob caj noob ces. Kev ntsuam xyuas cov kab mob hloov pauv tuaj yeem cuam tshuam rau kev txiav txim siab kho mob qog noj ntshav xws li BRCA1 thiab BRCA2 kev hloov pauv hauv lub mis, zes qe menyuam, prostate, thiab qog nqaij hlav pancreatic. Germline mutations kuj tseem muaj feem cuam tshuam rau kev kuaj mob qog noj ntshav thiab tiv thaiv cov neeg mob yav tom ntej. Cov neeg mob uas muaj peev xwm tsim nyog rau kev ntsuam xyuas cov kab mob hloov pauv yuav tsum ua kom tau raws li qee yam xwm txheej, uas muaj feem cuam tshuam xws li tsev neeg keeb kwm mob qog noj ntshav, hnub nyoog ntawm kev kuaj mob, thiab hom mob qog noj ntshav. Txawm li cas los xij, ntau tus neeg mob (txog 50%) uas nqa cov kab mob sib kis hauv kab kab mob tsis ua raws li cov txheej txheem ib txwm muaj rau kev kuaj kab mob kab mob hloov pauv raws li tsev neeg keeb kwm. Yog li ntawd, txhawm rau txhawm rau txhawm rau txheeb xyuas cov neeg muaj kev hloov pauv, National Comprehensive Cancer Network (NCCN) pom zoo kom tag nrho lossis feem ntau cov neeg mob uas muaj lub mis, zes qe menyuam, endometrial, pancreatic, mob qog noj ntshav, lossis mob qog nqaij hlav prostate rau kev kuaj kab mob.
Hais txog lub sij hawm ntawm kev ntsuam xyuas caj ces, vim tias feem ntau ntawm kev kho mob tseem ceeb ntawm kev hloov pauv yog clonal thiab kuj ruaj khov thaum lub sij hawm ntawm kev mob qog noj ntshav, nws tsim nyog ua cov tshuaj ntsuam genetic rau cov neeg mob thaum lub sij hawm kuaj mob cancer siab. Rau kev kuaj caj ces tom ntej, tshwj xeeb tshaj yog tom qab kev kho mob molecular, kev kuaj ctDNA yog qhov zoo dua li cov qog nqaij hlav DNA, vim tias cov ntshav DNA tuaj yeem muaj DNA los ntawm tag nrho cov qog nqaij hlav, uas yog qhov tsim nyog kom tau txais cov ntaub ntawv hais txog qog heterogeneity.
Kev soj ntsuam ntawm ctDNA tom qab kev kho mob yuav tuaj yeem kwv yees cov qog nqaij hlav rau kev kho mob thiab txheeb xyuas cov kab mob ua ntej tshaj li cov qauv duab. Txawm li cas los xij, cov txheej txheem rau kev siv cov ntaub ntawv no los qhia kev txiav txim siab kho mob tsis tau tsim, thiab kev tshuaj xyuas ctDNA tsis pom zoo tshwj tsis yog hauv kev sim tshuaj. ctDNA kuj tseem tuaj yeem siv los ntsuas cov kab mob me me tom qab kev phais mob qog nqaij hlav. Kev kuaj ctDNA tom qab kev phais yog qhov muaj kev kwv yees ntawm cov kab mob txuas ntxiv thiab tuaj yeem pab txiav txim siab seb tus neeg mob puas yuav tau txais txiaj ntsig los ntawm kev siv tshuaj kho mob ntxiv, tab sis nws tseem tsis tau pom zoo kom siv ctDNA sab nraud ntawm kev sim tshuaj los coj cov kev txiav txim siab kho mob ntxiv.

Kev ua cov ntaub ntawv Thawj kauj ruam hauv genome sequencing yog rho tawm DNA los ntawm cov neeg mob kuaj, npaj cov tsev qiv ntawv, thiab tsim cov ntaub ntawv nyoos sequencing. Cov ntaub ntawv nyoos yuav tsum tau ua ntxiv, suav nrog kev lim cov ntaub ntawv tsis zoo, muab piv nrog cov ntaub ntawv siv genome, txheeb xyuas ntau hom kev hloov pauv los ntawm kev sib txawv analytical algorithms, txiav txim siab cov txiaj ntsig ntawm cov kev hloov pauv ntawm cov protein txhais lus, thiab lim cov kab hloov pauv.
Tus tsav tsheb gene annotation yog tsim los kom paub qhov txawv ntawm tus tsav tsheb thiab cov neeg caij tsheb sib hloov. Kev hloov pauv ntawm tus tsav tsheb ua rau poob lossis txhim kho cov qog nqaij hlav qog ua haujlwm. Cov kev hloov me me uas ua rau qhov tsis ua haujlwm ntawm cov qog nqaij hlav qog muaj xws li kev hloov pauv tsis tseem ceeb, hloov pauv hloov pauv, thiab qhov hloov pauv qhov tseem ceeb ntawm qhov chaw, nrog rau tsis tshua muaj pib codon deletion, nres codon deletion, thiab ntau yam kev hloov pauv ntawm intron insertion / deletion. Tsis tas li ntawd, kev hloov pauv tsis zoo thiab kev hloov pauv me me hauv qhov nkag / tshem tawm kuj tuaj yeem ua rau poob ntawm cov qog qog ua haujlwm ntawm cov noob caj noob ces thaum cuam tshuam rau cov haujlwm tseem ceeb. Cov qauv sib txawv uas ua rau poob ntawm cov qog suppressor noob kev ua haujlwm suav nrog ib feem lossis ua tiav cov noob tshem tawm thiab lwm yam genomic variants uas ua rau kev puas tsuaj ntawm cov noob nyeem ntawv. Cov kev hloov me me uas ua rau muaj kev ua haujlwm zoo ntawm oncogenes suav nrog kev hloov pauv tsis zoo thiab qee zaus intron insertions / deletions uas lub hom phiaj tseem ceeb ntawm cov protein ua haujlwm. Nyob rau hauv tsawg zaus, protein truncation los yog splicing site mutations tuaj yeem ua rau muaj kev ua haujlwm ntawm oncogenes. Cov qauv kev hloov pauv uas ua rau kev ua kom oncogene muaj xws li gene fusion, gene deletion, thiab gene duplication.
Kev kho mob txhais lus ntawm genomic variation ntsuam xyuas qhov tseem ceeb ntawm cov kev hloov pauv uas tau txheeb xyuas, piv txwv li lawv cov peev xwm kuaj mob, prognostic, lossis kho tus nqi. Muaj ntau qhov pov thawj-raws li kev muab qhab nia uas tuaj yeem siv los qhia kev txhais lus kho mob ntawm genomic variation.
Lub Chaw Memorial Sloan-Kettering Cancer Center's Precision Medicine Oncology Database (OncoKB) faib cov noob sib txawv rau hauv plaub theem raws li lawv qhov kev kwv yees tus nqi rau kev siv tshuaj: Qib 1/2, FDA pom zoo, lossis cov kws kho mob-tus qauv biomarkers uas kwv yees cov lus teb ntawm cov lus qhia tshwj xeeb rau cov tshuaj pom zoo; Qib 3, FDA pom zoo lossis tsis pom zoo biomarkers uas kwv yees cov lus teb rau cov tshuaj tshiab uas tau pom zoo cog lus hauv kev sim tshuaj, thiab Qib 4, tsis yog FDA pom zoo biomarkers uas kwv yees cov lus teb rau cov tshuaj tshiab uas tau pom muaj pov thawj pov thawj lom neeg hauv kev sim tshuaj. Ib pab pawg thib tsib cuam tshuam nrog kev kho mob kuj tau ntxiv.
American Society for Molecular Pathology (AMP)/American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) cov lus qhia rau kev txhais lus ntawm somatic variation faib somatic variation ua plaub pawg: Qib I, nrog rau kev kho mob tseem ceeb; Qib II, nrog rau qhov tseem ceeb ntawm kev kho mob; Qib III, tsis paub qhov tseem ceeb ntawm kev kho mob; Qib IV, tsis paub tias tseem ceeb hauv kev kho mob. Tsuas yog qib I thiab II qhov txawv ntawm qhov tseem ceeb rau kev txiav txim siab kho mob.
ESMO's Molecular Target Clinical Operability Scale (ESCAT) faib cov noob sib txawv rau hauv rau qib: Qib I, cov hom phiaj tsim nyog rau kev siv niaj hnub; Theem II, lub hom phiaj tseem tab tom kawm, yuav raug siv los tshuaj xyuas cov neeg mob uas tuaj yeem tau txais txiaj ntsig los ntawm lub hom phiaj tshuaj, tab sis xav tau cov ntaub ntawv ntau ntxiv los txhawb nws. Qib III, cov hom kab mob sib txawv uas tau pom muaj txiaj ntsig zoo hauv lwm hom mob qog noj ntshav; Qib IV, tsuas yog tsom cov noob hloov pauv tau txhawb los ntawm cov pov thawj preclinical; Hauv qib V, muaj pov thawj los txhawb qhov tseem ceeb ntawm kev kho mob ntawm lub hom phiaj ntawm kev hloov pauv, tab sis kev kho ib leeg-tshuaj tiv thaiv lub hom phiaj tsis ua kom muaj sia nyob, lossis kev siv cov tswv yim kho mob ua ke tuaj yeem siv tau; Qib X, tsis muaj nqi kho mob.