Department of Sarcoma Medical Oncology, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas 77030, USA.
J Surg Oncol. 2010 Mar 15;101(4):327-33. doi: 10.1002/jso.21481.
Unlike epithelial cancers that are both more homogeneous and easily categorized by their respective tissues of origin (e.g., breast or lung cancer), sarcomas represent a diverse class of molecularly distinct bone and soft-tissue mesenchymal neoplasms of more than 50 subtypes. This diversity, as well as the relative rarity of sarcomas as a whole, has presented challenges in conducting prospective randomized clinical trials to assess the value of neoadjuvant chemotherapy for any given subtype. Most clinical trials and meta-analyses have neglected the phenotypic and molecular heterogeneity differentiating one sarcoma subtype from another in favor of a simplified grouping that ensures timely trial completion. As the success of treating gastrointestinal stromal tumors (GISTs) with imatinib demonstrates, a decision to provide neoadjuvant chemotherapy must take into consideration both the subtype being treated and the effect such treatment would be expected to exert upon that subtype.
与上皮癌不同，上皮癌的组织起源更加同质，并且易于分类（例如，乳腺癌或肺癌），而肉瘤代表了一大类分子上不同的骨和软组织间充质肿瘤，超过 50 种亚型。这种多样性，以及肉瘤作为一个整体的相对罕见性，给评估新辅助化疗对任何特定亚型的价值的前瞻性随机临床试验带来了挑战。大多数临床试验和荟萃分析都忽略了区分一种肉瘤亚型与另一种亚型的表型和分子异质性，而倾向于采用简化的分组方式，以确保及时完成试验。正如用伊马替尼治疗胃肠道间质瘤（GISTs）的成功所表明的那样，提供新辅助化疗的决定必须考虑到所治疗的亚型以及这种治疗预计对该亚型产生的影响。
