Viner Jaye L, Umar Asad, Hawk Ernest T
Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Division of Cancer Prevention, EPN, Suite 2141, 6130 Executive Boulevard, Bethesda, MD 20892-7317, USA.
Gastroenterol Clin North Am. 2002 Dec;31(4):971-99. doi: 10.1016/s0889-8553(02)00055-9.
Chemoprevention holds great promise as a complement to traditional CRC screening and treatment. Effective chemopreventive agents might improve patient outcomes by reducing the number of missed lesions, the morbidity associated with their identification and treatment, and their malignant potential. In addition, chemoprevention may reduce neoplastic potential simultaneously in several organs and improve clinical outcomes for persons at risk for cancers at multiple sites (e.g., colorectal and extracolonic cancers in HNPCC cohorts). Complex molecular circuits underlie the disease mosaic that is associated with aging. Several of these diseases share common mechanisms against which preventive interventions appear to be effective, such as NSAIDs for colorectal neoplasia and neurodegenerative disease, and statins for cardiovascular disease and colorectal neoplasia. Understanding these mechanisms and effects could raise prevention science to an entirely new level. The number of trials that are investigating chemopreventives against CR neoplasia is relatively small; if these agents live up to a fraction of their promise, the public health impact may be great (see Table 6).
化学预防作为传统结直肠癌筛查和治疗的补充具有巨大潜力。有效的化学预防剂可能通过减少漏诊病变的数量、与其识别和治疗相关的发病率以及其恶性潜能来改善患者预后。此外，化学预防可能同时降低多个器官的肿瘤发生潜能，并改善多部位癌症高危人群（如遗传性非息肉病性结直肠癌队列中的结直肠癌和结肠外癌症）的临床结局。复杂的分子回路构成了与衰老相关的疾病拼图的基础。其中一些疾病具有共同的机制，针对这些机制的预防性干预似乎是有效的，例如用于结直肠肿瘤和神经退行性疾病的非甾体抗炎药，以及用于心血管疾病和结直肠肿瘤的他汀类药物。了解这些机制和作用可能会将预防科学提升到一个全新的水平。正在研究针对结直肠癌的化学预防剂的试验数量相对较少；如果这些药物能实现其部分承诺，对公共卫生的影响可能会很大（见表6）。
