Cortesina G, Martone T
Division of Otorhinolaryngology, Department of Clinical Physiopathology, University of Turin, Italy.
Acta Otorhinolaryngol Ital. 2006 Dec;26(6):317-25.
It is now widely accepted that the presence of lymph node metastases is a negative prognostic factor in head and neck squamous cell carcinoma. It follows that the ability to determine the presence of micro-metastases or the metastatic potential of a tumour at an early stage would condition the therapeutic strategy and evolution of this type of tumour. Prediction of the metastatic potential of head and neck squamous cell carcinoma is still, today, entrusted to clinical and histological evaluation of the tumour. However, the high percentage of relapse in this tumour shows the inadequacy of these parameters in predicting metastatic potential. Furthermore, progress made over the last ten years in understanding the molecular mechanisms involved in the process of neoplastic tumour progression has led to the identification of molecules that can be used as potential prognostic markers of head and neck squamous cell carcinoma. There are many molecules involved in the process of forming metastases. This process represents the final stage of a multistep model, in which alterations occur to genes that are important for growth, proliferation and migration, to which are added variations in the expression of molecules involved in the process of homeostasis of the extra-cellular matrix, of angiogenesis and lymphangiogenesis, favouring tumour invasion and the formation of metastases. This review of the literature shows that the tumour invasion process is associated with numerous molecular alterations that might be used as potential prognostic molecular markers. However, none of these alterations is univocally associated with the metastasization used in clinical practice. Further studies on larger series and on a larger scale, such as genome studies, and preclinical studies on markers used as targets in specific therapies, will provide a valuable contribution to their use in clinical practice in the short term.
目前，人们广泛认为淋巴结转移的存在是头颈部鳞状细胞癌的一个负面预后因素。因此，在早期确定微转移的存在或肿瘤的转移潜能的能力将决定这类肿瘤的治疗策略和发展。如今，头颈部鳞状细胞癌转移潜能的预测仍依赖于对肿瘤的临床和组织学评估。然而，这类肿瘤的高复发率表明这些参数在预测转移潜能方面并不充分。此外，在过去十年中，对肿瘤进展过程中涉及的分子机制的理解取得了进展，这导致了可作为头颈部鳞状细胞癌潜在预后标志物的分子的鉴定。转移形成过程涉及许多分子。这个过程代表了一个多步骤模型的最后阶段，在这个模型中，对生长、增殖和迁移重要的基因发生改变，此外，参与细胞外基质稳态、血管生成和淋巴管生成过程的分子表达也发生变化，从而促进肿瘤侵袭和转移形成。这篇文献综述表明，肿瘤侵袭过程与许多可能用作潜在预后分子标志物的分子改变有关。然而，这些改变中没有一个与临床实践中使用的转移有明确的关联。对更大系列样本和更大规模的进一步研究，如基因组研究，以及对用作特定治疗靶点的标志物的临床前研究，将在短期内为它们在临床实践中的应用做出有价值的贡献。
