Eccles Suzanne A, Welch Danny R
Tumour Biology and Metastasis, Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, UK.
Lancet. 2007 May 19;369(9574):1742-57. doi: 10.1016/S0140-6736(07)60781-8.
Most cancer deaths are due to the development of metastases, hence the most important improvements in morbidity and mortality will result from prevention (or elimination) of such disseminated disease. Some would argue that treatments directed against metastasis are too late because cells have already escaped from the primary tumour. Such an assertion runs contrary to the significant but (for many common adult cancers) fairly modest improvements in survival following the use of adjuvant radiation and chemotherapy designed to eliminate disseminated cells after surgical removal of the primary tumour. Nonetheless, the debate raises important issues concerning the accurate early identification of clonogenic, metastatic cells, the discovery of novel, tractable targets for therapy, and the monitoring of minimal residual disease. We focus on recent findings regarding intrinsic and extrinsic molecular mechanisms controlling metastasis that determine how, when, and where cancers metastasise, and their implications for patient management in the 21st century.
大多数癌症死亡是由转移灶的形成所致，因此，发病率和死亡率的最重要改善将源于对这种播散性疾病的预防（或消除）。有些人可能会争辩说，针对转移的治疗为时已晚，因为癌细胞已经从原发肿瘤中逃逸。这种说法与使用辅助放疗和化疗后生存率的显著提高（但对于许多常见的成人癌症而言，提高幅度相当有限）相悖，辅助放疗和化疗旨在在手术切除原发肿瘤后消除播散的细胞。尽管如此，这场争论提出了一些重要问题，涉及克隆性转移细胞的准确早期识别、新型可治疗靶点的发现以及微小残留病的监测。我们关注有关控制转移的内在和外在分子机制的最新发现，这些机制决定了癌症转移的方式、时间和位置及其对21世纪患者管理的影响
