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博克曼再探:21 世纪的子宫内膜癌“类型”。

Bokhman Redux: Endometrial cancer "types" in the 21st century.

机构信息

Department of Pathology, College of Medicine, The Ohio State University, United States.

Division of Epidemiology, College of Public Health, The Ohio State University, United States.

出版信息

Gynecol Oncol. 2017 Feb;144(2):243-249. doi: 10.1016/j.ygyno.2016.12.010. Epub 2016 Dec 16.

Abstract

In 1983 Jan V. Bokhman, M.D. published a landmark paper entitled "Two Pathogenetic Types of Endometrial Carcinoma" in which an enduring dualistic view of endometrial cancer was first proposed. "Type I" cancers are thought to represent estrogen driven mostly low grade endometrioid tumors strongly associated with obesity and other components of the metabolic syndrome. "Type II" cancers represent higher grade non-endometrioid tumors for which the latter associations are less significant. Basic tenets of this dichotomy including significant prognostic differences have been abundantly confirmed by later literature. The construct has in turn contributed a useful framework for decades of teaching and scientific advancement across disciplines. However, recent large epidemiologic studies indicate a more complex web of risk factors with obesity and hormones likely playing an important role across the entire endometrial cancer histologic and clinical spectrum. Moreover, high quality molecular data and refinements in pathologic classification challenge any simplistic classification of endometrial cancer. For example, the Cancer Genome Atlas (TCGA) recently defined four clinically distinct endometrial cancer types based on their overall mutational burden, specific p53, POLE and PTEN mutations, microsatellite instability and histology. Additionally, new histologic categories with clear prognostic implications have been accepted and it is becoming evident from an epidemiologic point of view that metabolic factors may play an important role in endometrial cancer overall. While Bokhman's intuitive dualistic model remains relevant when working with large registries and databases lacking granular information; most other efforts should integrate clinical, pathological and molecular specifics into more nuanced classifications.

摘要

1983 年,医学博士扬·V·博克曼(Jan V. Bokhman)发表了一篇具有里程碑意义的论文,题为“子宫内膜癌的两种发病类型”,首次提出了一种持久的子宫内膜癌二元论观点。“I 型”癌症被认为代表了主要由雌激素驱动的低度子宫内膜样肿瘤,与肥胖和代谢综合征的其他成分密切相关。“II 型”癌症代表了更高分级的非子宫内膜样肿瘤,后者的相关性不那么显著。这种二分法的基本原则,包括显著的预后差异,已经被后来的文献大量证实。几十年来,这种结构为跨学科的教学和科学进步提供了一个有用的框架。然而,最近的大型流行病学研究表明,风险因素更为复杂,肥胖和激素可能在整个子宫内膜癌的组织学和临床谱中发挥重要作用。此外,高质量的分子数据和病理分类的改进对任何简单的子宫内膜癌分类都提出了挑战。例如,癌症基因组图谱(Cancer Genome Atlas,TCGA)最近根据其总体突变负担、特定的 p53、POLE 和 PTEN 突变、微卫星不稳定性和组织学,定义了四种临床上不同的子宫内膜癌类型。此外,具有明确预后意义的新组织学类别已经被接受,从流行病学的角度来看,代谢因素可能在整个子宫内膜癌中发挥重要作用。虽然博克曼的直观二元模型在处理缺乏详细信息的大型注册中心和数据库时仍然相关;但大多数其他研究应该将临床、病理和分子细节整合到更细致的分类中。

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