Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Institute, London, 5 University Street, London WC1E 6JF, UK; Department of Thoracic Medicine, University College London Hospital, 235 Euston Road, London NW1 2BU, UK.
Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Institute, London, 5 University Street, London WC1E 6JF, UK.
Cancer Treat Rev. 2017 Jul;58:77-90. doi: 10.1016/j.ctrv.2017.05.009. Epub 2017 Jul 10.
Squamous cell carcinoma of the lung arises from preinvasive progenitors in the central airways. The archetypal model appears to be a stepwise morphological progression until there is invasion of the basement membrane. However, not every lesion appears to follow this course and many individuals can have stable disease, or indeed regress to normal epithelium. From our increased understanding of the molecular pathology it is becoming apparent that the respiratory epithelium accumulates progressive genetic and epigenetic insults in response to carcinogens. Still, little is known about how to predict those 'at risk' of progression, and it is likely that in the future molecular signatures will underpin prediction models of developing invasive lung cancer. Currently, autofluorescence bronchoscopy gives us the ability to follow the natural history of these lesions, with the prospect that detecting and treating lesions early may improve survival. However, treatment remains controversial, and radical therapies are offered to individuals with carcinoma in situ who may never develop invasive cancer. This has paved the way for the use of minimally invasive bronchoscopic treatments, which, while apparently effective, have not been tested in randomised controlled trials. In this paper we describe the known biology and natural history of preinvasive lesions and review the current treatment strategies.
肺鳞状细胞癌起源于中央气道的癌前祖细胞。典型的模式似乎是一个逐步的形态学进展，直到基底膜被侵犯。然而，并非每个病变都遵循这一过程，许多患者的疾病可以稳定，甚至可以回归正常上皮。从我们对分子病理学的深入了解中可以明显看出，呼吸道上皮细胞会因致癌物而逐渐积累遗传和表观遗传损伤。尽管如此，人们对如何预测那些有进展风险的患者知之甚少，未来分子特征可能会为发展为浸润性肺癌的预测模型提供支持。目前，自发荧光支气管镜检查使我们能够跟踪这些病变的自然史，有希望的是，早期发现和治疗病变可能会提高生存率。然而，治疗仍然存在争议，对于原位癌患者提供了激进的治疗方法，而这些患者可能永远不会发展为浸润性癌症。这为使用微创支气管镜治疗铺平了道路，虽然这些治疗方法显然是有效的，但尚未在随机对照试验中进行测试。在本文中，我们描述了癌前病变的已知生物学和自然史，并回顾了当前的治疗策略。
