Department of Oncology, University of Western Ontario, London, Canada.
Bioessays. 2012 Jan;34(1):72-82. doi: 10.1002/bies.201100049. Epub 2011 Nov 22.
Cancer viewed as a programmed, evolutionarily conserved life-form, rather than just a random series of disease-causing mutations, answers the rarely asked question of what the cancer cell is for, provides meaning for its otherwise mysterious suite of attributes, and encourages a different type of thinking about treatment. The broad but consistent spectrum of traits, well-recognized in all aggressive cancers, group naturally into three categories: taxonomy ("phylogenation"), atavism ("re-primitivization") and robustness ("adaptive resilience"). The parsimonious explanation is not convergent evolution, but the release of an highly conserved survival program, honed by the exigencies of the Pre-Cambrian, to which the cancer cell seems better adapted; and which is recreated within, and at great cost to, its host. Central to this program is the Warburg Effect, whose malign influence permeates well beyond aerobic glycolysis to include biomass interconversion and genomic heuristics. Warburg-type metabolism and genomic instability are targets whose therapeutic disablement is a major priority.
将癌症视为一种程序化的、进化上保守的生命形式，而不仅仅是一系列随机的致病突变，可以回答一个很少被问到的问题，即癌细胞的作用是什么，为其神秘的属性提供了意义，并鼓励人们以不同的方式思考治疗方法。在所有侵袭性癌症中都能明显识别出的广泛但一致的特征，自然地分为三类：分类学（“进化”）、返祖现象（“再原始化”）和健壮性（“适应性弹性”）。简洁的解释不是趋同进化，而是一种高度保守的生存程序的释放，这种程序是由前寒武纪的苛刻条件磨练出来的，癌细胞似乎更适应这种程序；这种程序在其宿主内部被重新创造出来，并付出了巨大的代价。这个程序的核心是沃伯格效应，其恶性影响不仅渗透到有氧糖酵解，还包括生物质转化和基因组启发式。沃伯格型代谢和基因组不稳定性是治疗的主要目标。
