Mulshine J L, De Luca L M, Dedrick R L, Tockman M S, Webster R, Placke M E
National Cancer Institute, Bethesda, Maryland 20892-1906, USA.
Cancer. 2000 Dec 1;89(11 Suppl):2465-7. doi: 10.1002/1097-0142(20001201)89:11+<2465::aid-cncr24>3.3.co;2-y.
The current mortality rate for lung cancer exceeds 85%, as it has for the last 3 decades. This statistic reflects the utility of the major diagnostic tool that has been used during this period to diagnose lung cancer: the chest X-ray. The overwhelming majority of new cases of lung cancer that are detected with chest X-rays involve individuals who already have regional or distant metastatic disease. Because the systemic treatment of this disease has not improved greatly, patients with metastatic disease rarely are cured. This article reviews the issues involved with the development of sputum-based cellular diagnostics for early stage lung cancer. The biomarker, heterogeneous nuclear ribonucleoprotein A2/B1, is the lead marker for this approach. It has been used in several studies in independent cohorts that have suggested that its overexpression in bronchial epithelial cells is associated highly with the development of lung cancer. This marker is detectable 1 year or more prior to the detection of lung cancer by chest X-ray. Finding this early airway-confined phase of lung cancer may allow for the evolution of new management approaches for very early stage lung cancer. Research activities, such aerosolized chemoprevention, are discussed.
目前肺癌的死亡率超过85%，在过去三十年一直如此。这一统计数据反映了在此期间用于诊断肺癌的主要诊断工具——胸部X光的效用。通过胸部X光检测出的绝大多数肺癌新病例都涉及已经出现区域或远处转移疾病的个体。由于这种疾病的全身治疗没有太大改善，转移性疾病患者很少能被治愈。本文综述了用于早期肺癌的痰基细胞诊断方法所涉及的问题。生物标志物异质性核糖核蛋白A2/B1是这种方法的主要标志物。它已在多个独立队列的研究中使用，这些研究表明其在支气管上皮细胞中的过表达与肺癌的发生高度相关。在通过胸部X光检测到肺癌的一年或更早之前就能检测到该标志物。发现肺癌的这个早期气道局限阶段可能会促使针对极早期肺癌的新管理方法的发展。文中还讨论了雾化化学预防等研究活动。
