Goldfarb Y, Ben-Eliyahu S
Neuroimmunology Research Unit, Department of Psychology, Tel-Aviv University, Tel-Aviv 69978, Israel.
Breast Dis. 2006;26:99-114. doi: 10.3233/bd-2007-26109.
Surgical resection of the primary tumor is a necessary and effective treatment for breast cancer patients. For various reasons discussed, we believe that the short postoperative period is critical for eliminating minimal residual disease (MRD), thus markedly impacting long term survival. Unfortunately, both animal and human studies have shown that surgery induces suppression of anti-metastatic cell-mediated immunity (CMI) at this critical period, which is suggested to worsen patients' prognosis. In this review we examine different aspects of the surgical procedure that cause immunosuppression (e.g., anesthesia and tissue damage), discuss their mediating humoral and cellular mechanisms, and suggest prophylactic interventions feasible in cancer patients to avoid postoperative suppression of CMI. The use of the suggested interventions has been shown to significantly reduce postoperative metastasis in animal models, including mammary adenocarcinoma, and initial data suggest similar efficacy in breast cancer patients. We believe that our recommended prophylactic interventions can easily be applied by health-care practitioners and hold promise in reducing long-term recurrence and metastasis in cancer patients.
对乳腺癌患者而言，手术切除原发性肿瘤是一种必要且有效的治疗方法。基于所讨论的各种原因，我们认为术后短期内对于清除微小残留病灶（MRD）至关重要，进而对长期生存产生显著影响。不幸的是，动物和人体研究均表明，手术在此关键时期会诱导抗转移细胞介导免疫（CMI）受到抑制，这被认为会使患者预后恶化。在本综述中，我们研究了导致免疫抑制的手术过程的不同方面（如麻醉和组织损伤），讨论了其介导的体液和细胞机制，并提出了在癌症患者中可行的预防性干预措施，以避免术后CMI受到抑制。在包括乳腺腺癌在内的动物模型中，使用所建议的干预措施已显示可显著减少术后转移，初步数据表明其在乳腺癌患者中也有类似疗效。我们相信，我们推荐的预防性干预措施可由医护人员轻松应用，并有望减少癌症患者的长期复发和转移。
