Penapis tumor M2-PK: Perbedaan antara revisi

M2-PK muncul pada banyak tumor.<ref name="Reinacher">{{cite journal|author = Reinacher M, Eigenbrodt E|title = Immunohistological demonstration of the same type of pyruvate kinase isoenzyme (M2-PK) in tumors of chicken and rat |journal = Virchows Arch. B Cell Pathol. Incl. Mol. Pathol. |year = 1981|volume = 37|pages = 79–88|pmid = 6116351|doi = 10.1007/BF02892557|issue = 1}}</ref><ref name="Brinck">{{cite journal|author = Brinck U, Eigenbrodt E, Oehmke M, Mazurek S, Fischer G|title = L- and M2-pyruvate kinase expression in renal cell carcinomas and their metastases |journal = Virchows Arch. |year = 1994|volume = 424|pages = 177–185|pmid = 8180780|doi = 10.1007/BF00193498|issue = 2}}</ref><ref name="Steinberg">{{cite journal|author = Steinberg P, Klingelhöffer A, Schäfer A, Wüst G, Weisse G, Oesch F, Eigenbrodt E|title = Expression of pyruvate kinase M2 in preneoplastic hepatic foci of N-nitrosomorpholine-treated rats |journal = Virchows Arch. |year = 1999|volume = 434|pages = 213–220|pmid = 10190300|doi = 10.1007/s004280050330|issue = 3}}</ref> PK-M1 akan berubah menjadi PK-M2 selama proses terjadinya tumor.<ref name="Christofk2008b">{{cite journal | author = Christofk HR, Vander Heiden MG, Harris MH, Ramanathan A, Gerszten RE, Wei R, Fleming MD, Schreiber SL, Cantley LC | title = The M2 splice isoform of pyruvate kinase is important for cancer metabolism and tumour growth | journal = Nature | volume = 452 | issue = 7184 | pages = 230–3 | year = 2008 | pmid = 18337823 | doi = 10.1038/nature06734 }}</ref> Tes M2-PK adalah [[penapis tumor]] non-invasif untuk deteksi awal [[kanker usus besar]], dan [[polip]] yang dapat menjadi awal dari kanker usus besar. Tes M2-PK untuk analisaanalisis kotoran manusia tersedia dalam bentuk tes kuatitatif penuh [[ELISA]] atau tes cepat yang dapat dilakukan oleh semua tenaga medis tanpa membutuhkan laboratorium klinik atau peralatan apapun. Pada prinsipnya tes cepat ini yang hanya membutuhkan beberapa menit saja, mirip dengan tes cepat kehamilan, hanya lebih rumit sedikit, tetapi sebenarnya siapapun yang dapat memahami instruksi dengan baik dapat melakukannya. Di Indonesia tes kuantitatif penuh telah ada di RS Kanker, sedangkan penjualan kit tes cepat belum dijumpai di Indonesia, tetapi di Eropa banyak dijumpai.

Ensim M2-PK adalah ensim kunci dari kanker usus besar dan polip. Deteksi M2-PK tidak bergantung pada darah pada kotoran manusia dan tes ini lebih spesifik terhadap metabolisme tumor. Positip palsu yang mungkin terjadi karena [[wasir]]/ambeien dan pendarahan non-tummor/polip dapat diabaikan dalam tes M2-PK ini, oleh karenanya tes M2-PK dapat dilakukan pada saat terjadinya pendarahan ataupun tidak. Tes M2-PK dapat mendeteksi 80.3% dari [[kanker usus besar]].<ref>C. Tonus, M. Sellinger u. a.: Faecal pyruvate kinase isoenzyme type M2 for colorectal cancer screening: A meta-analysis. In: World journal of gastroenterology : WJG. Band 18, Nummer 30, August 2012, S. 4004–4011, ISSN 1007-9327. doi:10.3748/wjg.v18.i30.4004. PMID 22912551. PMC 3419997.</ref> Tes M2-PK boleh dilakukan mulai pada mereka yang belum memperlihatkan gejala adanya [[kanker usus besar]]. Peningkatan konsentrasi pada M2-PK selalu harus diikuti oleh [[kolonoskopi]] untuk pengambilan sampel jika dibutuhkan dan dilakukan [[biopsi]]. Biopsi inilah yang disebutkan penegakan diagnosis, bukan kolonoskopinya.== Deteksi awal kanker usus besar dan polip==

M2-PK, yang diukur dari kotoran manusia, adalah [[penapis tumor]] yang wahid untuk [[kanker usus besar]]. Pengukuran pada kotoran manusia dengan [[cutoff value]] 4 U/ml, sensitivitas/kepekaannya diperkirakan sebesar 85% (dengan 95% [[confidence interval]] dari 65 hingga 96%) untuk kanker usus besar dan 56% (confidence interval 41–74%) untuk kanker anus (rectal cancer).<ref name=Haug2007>{{cite doi|10.1038/sj.bjc.6603712}}</ref> Spesifisitasnya adalah 95%.<ref>{{Cite web |url=http://www.wjgnet.com/1007-9327/pdf/v18/i30/4004.pdf |title=Salinan arsip |access-date=2015-03-17 |archive-date=2014-10-09 |archive-url=https://web.archive.org/web/20141009063826/http://www.wjgnet.com/1007-9327/pdf/v18/i30/4004.pdf |dead-url=yes }}</ref>

Tes M2-PK bukanlah tes darah samar, jadi dapat mendeteksi kanker usus besar dan polip pada kondisi pendarahan maupun tidak dengan tingkat sensitivitas dan spesifisitas yang tinggi dan '''tanpa negatip palsu''' (kalau negatip ya pasti negatip), tetapi positip palsu mungkin dapat terjadi.<ref>{{cite web |url=http://www.innogene-kalbiotech.com/category/products/marketed-products/diagnostics/tumor-m2-pk-stool-test/ |title=Tumor M2-PK Stool Test |accessdate=June 8, 2013 |archive-date=2013-04-20 |archive-url=https://web.archive.org/web/20130420052343/http://www.innogene-kalbiotech.com/category/products/marketed-products/diagnostics/tumor-m2-pk-stool-test/ |dead-url=yes }}</ref>

Penapis tumor M2-PK juga berguna untuk menapis [[kanker paru-paru]] dan lebih baik daripada penapis tumor [[Small-cell carcinoma|SCC]] dan [[Enolase 2|NSE]]. Jadi dapat lebih akurat, sekaligus menghemat biaya.<ref name="The significance of TU M2-PK tumor">{{cite journal |pmid=17882813 |year=2007 |last1=Oremek |first1=G |last2=Kukshaĭte |first2=R |last3=Sapoutzis |first3=N |last4=Ziolkovski |first4=P |title=The significance of TU M2-PK tumor marker for lung cancer diagnostics |volume=85 |issue=7 |pages=56–8 |journal=Klinicheskaia meditsina}}</ref> Selengkapnya penapis tumor M2-PK dapat menapis [[kanker usus besar]],<ref name=Haug2007>{{cite journal |doi=10.1038/sj.bjc.6603712 |title=Tumour M2-PK as a stool marker for colorectal cancer: Comparative analysis in a large sample of unselected older adults vs colorectal cancer patients |year=2007 |last1=Haug |first1=U |last2=Rothenbacher |first2=D |last3=Wente |first3=M N |last4=Seiler |first4=C M |last5=Stegmaier |first5=C |last6=Brenner |first6=H |journal=British Journal of Cancer}}</ref> [[Breast cancer]],<ref>{{cite journal |pmid=11326672 |year=2000 |last1=Lüftner |first1=D |last2=Mesterharm |first2=J |last3=Akrivakis |first3=C |last4=Geppert |first4=R |last5=Petrides |first5=PE |last6=Wernecke |first6=KD |last7=Possinger |first7=K |title=Tumor type M2 pyruvate kinase expression in advanced breast cancer |volume=20 |issue=6D |pages=5077–82 |journal=Anticancer research}}</ref><ref>{{cite journal |pmid=20592362 |year=2010 |last1=Benesch |first1=C |last2=Schneider |first2=C |last3=Voelker |first3=HU |last4=Kapp |first4=M |last5=Caffier |first5=H |last6=Krockenberger |first6=M |last7=Dietl |first7=J |last8=Kammerer |first8=U |last9=Schmidt |first9=M |title=The clinicopathological and prognostic relevance of pyruvate kinase M2 and pAkt expression in breast cancer |volume=30 |issue=5 |pages=1689–94 |journal=Anticancer research }}</ref> [[renal cell carcinoma]]<ref>{{cite journal |pmid=11326675 |year=2000 |last1=Oremek |first1=GM |last2=Sapoutzis |first2=N |last3=Kramer |first3=W |last4=Bickeböller |first4=R |last5=Jonas |first5=D |title=Value of tumor M2 (Tu M2-PK) in patients with renal carcinoma |volume=20 |issue=6D |pages=5095–8 |journal=Anticancer research}}</ref><ref>{{cite journal |pmid=10470199 |year=1999 |last1=Wechsel |first1=HW |last2=Petri |first2=E |last3=Bichler |first3=KH |last4=Feil |first4=G |title=Marker for renal cell carcinoma (RCC): The dimeric form of pyruvate kinase type M2 (Tu M2-PK) |volume=19 |issue=4A |pages=2583–90 |journal=Anticancer research}}</ref> [[Kanker paru-paru]],<ref name="The significance of TU M2-PK tumor"/><ref>{{cite journal |pmid=12624710 |year=2003 |last1=Schneider |first1=J |last2=Peltri |first2=G |last3=Bitterlich |first3=N |last4=Philipp |first4=M |last5=Velcovsky |first5=HG |last6=Morr |first6=H |last7=Katz |first7=N |last8=Eigenbrodt |first8=E |title=Fuzzy logic-based tumor marker profiles improved sensitivity of the detection of progression in small-cell lung cancer patients |volume=2 |issue=4 |pages=185–91 |doi=10.1007/s102380300005 |journal=Clinical and experimental medicine}}</ref><ref>{{cite journal |pmid=17882813 |year=2007 |last1=Oremek |first1=G |last2=Kukshaĭte |first2=R |last3=Sapoutzis |first3=N |last4=Ziolkovski |first4=P |title=The significance of TU M2-PK tumor marker for lung cancer diagnostics |volume=85 |issue=7 |pages=56–8 |journal=Klinicheskaia meditsina}}</ref> [[Pancreatic cancer]],<ref>{{cite journal |pmid=11326648 |year=2000 |last1=Hardt |first1=PD |last2=Ngoumou |first2=BK |last3=Rupp |first3=J |last4=Schnell-Kretschmer |first4=H |last5=Kloer |first5=HU |title=Tumor M2-pyruvate kinase: A promising tumor marker in the diagnosis of gastro-intestinal cancer |volume=20 |issue=6D |pages=4965–8 |journal=Anticancer research}}</ref> [[Esophageal Cancer]],<ref name="DoiMEGbef">{{cite journal |doi=10.1097/MEG.0b013e3280102f78 |title=Tumour M2-pyruvate kinase: A gastrointestinal cancer marker |year=2007 |last1=Kumar |first1=Yogesh |last2=Tapuria |first2=Niteen |last3=Kirmani |first3=Naveed |last4=Davidson |first4=Brian R. |journal=European Journal of Gastroenterology & Hepatology |volume=19 |issue=3 |pages=265}}</ref> [[Stomach Cancer]],<ref name="DoiMEGbef" /> [[Cervical Cancer]],<ref>{{cite journal |pmid=15210041 |year=2004 |last1=Kaura |first1=B |last2=Bagga |first2=R |last3=Patel |first3=FD |title=Evaluation of the Pyruvate Kinase isoenzyme tumor (Tu M2-PK) as a tumor marker for cervical carcinoma |volume=30 |issue=3 |pages=193–6 |doi=10.1111/j.1447-0756.2004.00187.x |journal=The journal of obstetrics and gynaecology research}}</ref> [[Ovarian Cancer]],<ref>{{cite journal |pmid=17479666 |year=2007 |last1=Ahmed |first1=AS |last2=Dew |first2=T |last3=Lawton |first3=FG |last4=Papadopoulos |first4=AJ |last5=Devaja |first5=O |last6=Raju |first6=KS |last7=Sherwood |first7=RA |title=M2-PK as a novel marker in ovarian cancer. A prospective cohort study |volume=28 |issue=2 |pages=83–8 |journal=European journal of gynaecological oncology}}</ref> Karena kegunaannya yang banyak maka penapis tumor M2-PK dapat digunakan sebagai penapis tumor awal yang dapat menggantikan CEA, CA-125 dan CA19-9 yang sensitivitasnya rendah.