Haier J, Nasralla M, Nicolson G L
The Institute for Molecular Medicine, Huntington Beach, California 92649-10941, USA.
Ann Surg. 2000 Jan;231(1):11-24. doi: 10.1097/00000658-200001000-00003.
Carcinomas of the colon and rectum are the third leading cause of cancer-related deaths. Although advances in the surgical treatment of primary colorectal cancers have lead to improvements in patient survival at early tumor stages, treatment of more progressive cancers has not resulted in dramatic improvements in patient survival. However, the selection of patient subgroups based on their prognosis and other characteristics could result in improved outcomes from adjuvant therapies in patients with Dukes B and C carcinomas.
The authors reviewed the available data on the value of cell surface molecules in assessing the prognosis of colorectal carcinomas, paying specific attention to the evaluation of statistical analysis and multivariate procedures.
Cell surface molecules have been identified on colorectal carcinoma cells whose expression appears to be related to malignant transformation, tumor progression, or patient prognosis. Among these cell surface molecules, various cell adhesion molecules, growth factor receptors, proteinases, and their receptors and inhibitors have been identified as potentially useful prognostic markers.
Although data exist on the prognostic values of certain cell surface markers, the use of multivariate analysis for the identification of valuable prognostic factors remains uncommon. Using reproducible and standardized multivariate analysis procedures, new tumor markers should be carefully examined for their biologic and prognostic relevance before being considered as potentially useful in the management of colorectal cancers.
结肠癌和直肠癌是癌症相关死亡的第三大主要原因。尽管原发性结直肠癌外科治疗的进展已使早期肿瘤阶段患者的生存率有所提高,但对进展性更强的癌症的治疗并未显著改善患者生存率。然而,根据患者的预后和其他特征选择患者亚组,可能会使Dukes B期和C期癌患者的辅助治疗效果得到改善。
作者回顾了关于细胞表面分子在评估结直肠癌预后方面价值的现有数据,特别关注统计分析和多变量程序的评估。
已在结肠癌细胞上鉴定出细胞表面分子,其表达似乎与恶性转化、肿瘤进展或患者预后相关。在这些细胞表面分子中,各种细胞粘附分子、生长因子受体、蛋白酶及其受体和抑制剂已被鉴定为潜在有用的预后标志物。
尽管存在关于某些细胞表面标志物预后价值的数据,但使用多变量分析来识别有价值的预后因素仍不常见。在将新的肿瘤标志物视为对结直肠癌管理可能有用之前,应使用可重复和标准化的多变量分析程序,仔细检查其生物学和预后相关性。