结直肠癌的分子基础:迈向个体化治疗?
Molecular basis of colorrectal cancer: towards an individualized management?
机构信息
Servicio de Cirugía General B. Hospital Universitario, Madrid. Spain.
出版信息
Rev Esp Enferm Dig. 2011 Jan;103(1):29-35. doi: 10.4321/s1130-01082011000100006.
Colorectal cancer (CRC) has become a highly relevant condition nowadays. In this respect, advances in the understanding of its molecular basis are key for an adequate management. From the time when the adenoma-carcinoma sequence was formulated as a carcinogenesis model to this day, when -among other things- three major carcinogenic pathways have been identified, the CRC concept has evolved from that of a single disease to the notion that each CRC is a differentiated condition in itself. The suppressor or chromosome instability pathway, the mutator or microsatellite instability pathway, and the methylator or CpG island methylation pathway allow various phenotypes to be identified within CRC. Similarly, the presence of different changes in certain genes confers several behaviors on CRC from both the prognostic and responsive standpoints to specific therapies. However, this apparent complexity does help develop the clinical management of this disease through the identification of novel, more specific therapy targets, and also markers for various behaviors within the condition, which will most likely lead us to an individualized management for these patients.
结直肠癌(CRC)如今已成为一种高度相关的疾病。在这方面,对其分子基础的理解的进步是进行适当管理的关键。从腺瘤-癌序列被提出作为一种致癌模型的时代,到今天,除其他外,已经确定了三种主要的致癌途径,CRC 的概念已经从单一疾病的概念演变为每个 CRC 本身都是一种不同的疾病的概念。抑癌基因或染色体不稳定性途径、突变基因或微卫星不稳定性途径和甲基化基因或 CpG 岛甲基化途径允许在 CRC 中识别各种表型。同样,某些基因中存在不同的变化,从预后和反应性的角度来看,赋予 CRC 几种行为,以及针对该疾病的特定治疗方法。然而,这种明显的复杂性确实有助于通过识别新的、更具体的治疗靶点,以及该疾病中各种行为的标志物,来改善对这种疾病的临床管理,这很可能会使我们对这些患者进行个体化管理。