Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Ann Epidemiol. 2012 Jul;22(7):520-30. doi: 10.1016/j.annepidem.2012.03.001. Epub 2012 Apr 4.
Increasing evidence suggests that altered immunity and chronic inflammation play a key role in the etiology of many malignancies, but the underlying biological mechanisms involved remain unclear. Systemic markers of immunity may not represent the clinically relevant, site-specific immune response, whereas tissue-based markers may more accurately reflect the local immunologic mechanisms by which precursor lesions develop into cancer. Tissues are often only available in individuals with disease. Previous studies have measured tumor-infiltrating lymphocytes to predict prognosis and survival, but it can be challenging to use tissue-based markers to study the natural history of cancer due to limitations with regard to temporality, the availability of appropriate comparison groups, and other epidemiologic issues. In this commentary, we discuss several epidemiologic study design and study population considerations to address these issues, including the strengths and limitations of using tissue-based markers to study immune response and cancer development. We also discuss how the use of tissue-based immune markers fits into the greater context of molecular epidemiology, which encompasses multiple technologies and techniques, and how implementation of tissue-based immune markers will provide an increased understanding of site-specific biological mechanisms involved in carcinogenesis.
越来越多的证据表明，免疫改变和慢性炎症在许多恶性肿瘤的病因学中起着关键作用，但相关的生物学机制仍不清楚。全身免疫标志物可能不能代表临床相关的、特定部位的免疫反应，而基于组织的标志物可能更能准确反映前体病变发展为癌症的局部免疫机制。组织通常仅在患有疾病的个体中获得。先前的研究已经测量了肿瘤浸润淋巴细胞来预测预后和存活，但由于时间性、适当对照组的可用性和其他流行病学问题的限制，使用基于组织的标志物来研究癌症的自然史具有挑战性。在这篇评论中，我们讨论了一些流行病学研究设计和研究人群的考虑因素，以解决这些问题，包括使用基于组织的标志物来研究免疫反应和癌症发展的优势和局限性。我们还讨论了基于组织的免疫标志物的使用如何融入更广泛的分子流行病学背景，其中包括多种技术和技术，以及基于组织的免疫标志物的实施将如何提供对致癌发生中涉及的特定部位生物学机制的更深入了解。
