Vermeulen Joëlle, De Preter Katleen, Mestdagh Pieter, Laureys Geneviève, Speleman Frank, Vandesompele Jo
Center for Medical Genetics, Ghent University Hospital, Ghent, B-9000, Belgium.
Discov Med. 2010 Jul;10(50):29-36.
One of the main challenges in clinical cancer research remains to be accurate outcome prediction at the time of diagnosis. Although not frequent in absolute terms, neuroblastoma represents an important clinical challenge, as it is fatal in almost half of the patients despite advances in multimodal anti-cancer therapies. Four major risk stratification systems for neuroblastoma patients are currently being used in various parts of the world. Systems are based on a combination of various clinical, histopathological, and biological factors. Accordingly, different therapeutic schemes exist ranging from wait-and-see approaches to intensive multimodal therapies. Clinical experience with the currently used risk stratification systems suggests that the stratification of patients for treatment is useful, but patients with the same clinico-pathological parameters, receiving the same treatment, can have markedly different clinical courses. Therefore, the challenge remains to identify additional tumor-specific and sensitive prognostic markers for improved risk estimation at the time of diagnosis and to improve the choice of risk-related therapy. Various studies have put forward new prognostic markers, including copy number aberrations, gene expression signatures, and epigenetic markers.
临床癌症研究的主要挑战之一仍然是在诊断时进行准确的预后预测。尽管从绝对数量上来说并不常见，但神经母细胞瘤是一个重要的临床挑战，因为尽管多模式抗癌疗法取得了进展，但几乎一半的患者仍会死亡。目前世界各地正在使用四种主要的神经母细胞瘤患者风险分层系统。这些系统基于各种临床、组织病理学和生物学因素的组合。因此，存在从观察等待方法到强化多模式疗法的不同治疗方案。目前使用的风险分层系统的临床经验表明，对患者进行治疗分层是有用的，但具有相同临床病理参数、接受相同治疗的患者可能会有明显不同的临床病程。因此，挑战仍然是识别额外的肿瘤特异性和敏感的预后标志物，以在诊断时改善风险估计，并改善与风险相关的治疗选择。各种研究已经提出了新的预后标志物，包括拷贝数变异、基因表达特征和表观遗传标志物。
