Wazir Umar, Mokbel Kinan, Carmichael Amtul, Mokbel Kefah
The London Breast Institute, Princess Grace Hospital, 45 Nottingham Place, London, W1U 5NY UK.
Cell Mol Biol Lett. 2017 Sep 4;22:20. doi: 10.1186/s11658-017-0049-x. eCollection 2017.
Clinicians use clinical and pathological parameters, such as tumour size, grade and nodal status, to make decisions on adjuvant treatments for breast cancer. However, therapeutic decisions based on these features tend to vary due to their subjectivity. Computational and mathematical algorithms were developed using clinical outcome data from breast cancer registries, such as Adjuvant! Online and NHS PREDICT. More recently, assessments of molecular profiles have been applied in the development of better prognostic tools.
Based on the available literature on online registry-based tools and genomic assays, we evaluated whether these online tools could be valid and accurate alternatives to genomic and molecular profiling of the individual breast tumour in aiding therapeutic decisions, particularly in patients with early ER-positive breast cancer.
Early breast cancer is currently considered a systemic disease and a complex ecosystem with behaviour determined by the complex genetic and molecular signatures of the tumour cells, mammary stem cells, microenvironment and host immune system. We anticipate that molecular profiling will continue to evolve, expanding beyond the primary tumour to include the tumour microenvironment, cancer stem cells and host immune system. This should further refine therapeutic decisions and optimise clinical outcome. This article was specially invited by the editors and represents work by leading researchers.
临床医生使用临床和病理参数，如肿瘤大小、分级和淋巴结状态，来做出乳腺癌辅助治疗的决策。然而，基于这些特征的治疗决策往往因主观性而有所不同。利用乳腺癌登记处的临床结果数据开发了计算和数学算法，如辅助在线工具（Adjuvant! Online）和英国国家医疗服务体系预测工具（NHS PREDICT）。最近，分子谱评估已应用于更好的预后工具的开发。
基于有关基于在线登记处的工具和基因组检测的现有文献，我们评估了这些在线工具是否可以成为个体乳腺肿瘤基因组和分子谱分析的有效且准确的替代方法，以辅助治疗决策，特别是在早期雌激素受体阳性乳腺癌患者中。
早期乳腺癌目前被认为是一种全身性疾病和一个复杂的生态系统，其行为由肿瘤细胞、乳腺干细胞、微环境和宿主免疫系统的复杂基因和分子特征决定。我们预计分子谱分析将继续发展，从原发肿瘤扩展到包括肿瘤微环境、癌症干细胞和宿主免疫系统。这应能进一步优化治疗决策并改善临床结果。本文由编辑特邀撰写，代表了顶尖研究人员的工作。
