Ceelen Wim, Pattyn Piet, Mareel Marc
Department of of Surgery, Ghent University Hospital, B-9000 Ghent, Belgium.
Department of of Surgery, Ghent University Hospital, B-9000 Ghent, Belgium.
Crit Rev Oncol Hematol. 2014 Jan;89(1):16-26. doi: 10.1016/j.critrevonc.2013.07.008. Epub 2013 Aug 16.
Surgery-induced acceleration of tumour growth has been observed since several centuries.
We reviewed recent insights from in vitro data, animal experimentation, and clinical studies on how surgery-induced wound healing or resection of a primary cancer influences the tumour-host ecosystem in patients harbouring minimal residual or metastatic disease.
Most of the growth factors, chemokines, and cytokines orchestrating surgical wound healing promote tumour growth, invasion, or angiogenesis. In addition, resection of a primary tumour may accelerate synchronous metastatic growth. In the clinical setting, indirect evidence supports the relevance of the above findings. Randomized clinical trials are underway comparing resection versus observation in metastatic breast and colon cancer with asymptomatic primary tumours.
In depth knowledge of how surgical intervention alters the tumour-host-metastasis communicating ecosystems could have important implications for clinical decision making in patients with synchronous metastatic disease and for the design and timing of multimodality treatment strategies.
几个世纪以来，人们一直观察到手术会加速肿瘤生长。
我们回顾了近期来自体外数据、动物实验和临床研究的见解，内容涉及手术诱导的伤口愈合或原发性癌症切除如何影响患有微小残留或转移性疾病患者的肿瘤-宿主生态系统。
大多数协调手术伤口愈合的生长因子、趋化因子和细胞因子会促进肿瘤生长、侵袭或血管生成。此外，原发性肿瘤的切除可能会加速同步转移性生长。在临床环境中，间接证据支持上述发现的相关性。正在进行随机临床试验，比较无症状原发性肿瘤的转移性乳腺癌和结肠癌患者的手术切除与观察情况。
深入了解手术干预如何改变肿瘤-宿主-转移沟通生态系统，可能对同步转移性疾病患者的临床决策以及多模式治疗策略的设计和时机具有重要意义。
