Hedley Benjamin D, Chambers Ann F
Division of Hematology, London Health Sciences Centre, London, Ontario, Canada.
Adv Cancer Res. 2009;102:67-101. doi: 10.1016/S0065-230X(09)02003-X.
Metastasis--the spread of cancer to distant organs--is responsible for most cancer deaths. Current adjuvant therapy is based on prognostic indicators that stratify patients into defined risk groups. However, some patients believed to have a good prognosis nonetheless develop metastases, in some cases many years after apparently successful treatment of their primary cancer. This period of clinical dormancy leads to many questions about how best to manage patients, including how to better assign risk of late recurrence, how long to monitor patients, and whether some patients will benefit from extended therapy to prevent late recurrences. The development of targeted therapies with fewer side effects is leading to clinical trials aimed at determining the effectiveness of such long-term therapy. However, much remains to be learned about tumor dormancy. Experimental studies are shedding light on biological and molecular mechanisms potentially responsible for tumor dormancy. Emerging research into tumor initiating cells, immunotherapy, and metastasis suppressor genes, may lead to new approaches for targeted antimetastatic therapy to prolong tumor dormancy. An improved understanding of tumor dormancy is needed for better management of patients at risk for late-developing metastases.
转移——癌症扩散至远处器官——是导致大多数癌症患者死亡的原因。目前的辅助治疗基于预后指标，这些指标将患者分为特定的风险组。然而，一些被认为预后良好的患者仍会发生转移，在某些情况下，是在其原发性癌症看似成功治疗多年之后。这段临床休眠期引发了许多关于如何最佳管理患者的问题，包括如何更好地评估晚期复发风险、对患者进行多长时间的监测，以及一些患者是否会从延长治疗中受益以预防晚期复发。副作用较少的靶向治疗的发展正促使开展临床试验，以确定这种长期治疗的有效性。然而，关于肿瘤休眠仍有许多有待了解之处。实验研究正在揭示可能导致肿瘤休眠的生物学和分子机制。对肿瘤起始细胞、免疫疗法和转移抑制基因的新兴研究，可能会带来靶向抗转移治疗的新方法，以延长肿瘤休眠期。为了更好地管理有晚期转移风险的患者，需要对肿瘤休眠有更深入的了解。
