Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy.
Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department, IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy.
Breast. 2018 Oct;41:42-50. doi: 10.1016/j.breast.2018.06.013. Epub 2018 Jun 22.
Different fields of cancer management consider bone health to be of increasing clinical importance for patients: 1) presence of bone metastases in many solid tumors, 2) use of bone-targeted treatments in the reduction of bone metastasis, 3) effects of cancer treatment on reproductive hormones, critical for normal bone remodeling maintenance. Additionally, bone microenvironment is further complicated by the decline of ovarian sex steroid production and by the related increase in inflammatory factors linked to menopause, which result in accelerated bone loss and increased risk of osteoporosis (OP). Similarly, cancers and metastasis to bone showed a close relationship with sex hormones (particularly estrogen). Thus, these findings raise a question: Could pre-existing estrogen deficiency OP promote and/or influence cancer cell homing and tumor growth in bone? Although some preclinical and clinical evidence exists, it is mandatory to understand this aspect that would be relevant in the clinical theatre, where physicians need to understand the treatments available to reduce the risk of skeletal disease in cancer patients. This descriptive systematic review summarizes preclinical and clinical studies dealing with bimodal interactions between pre-existing estrogen deficiency OP and bone metastasis development and provides evidence supporting differences in tumor growth and colonization between healthy and OP status. Few studies evaluated the impact of estrogen deficiency OP on the susceptibility to bone metastases. Therefore, implementing biological knowledge, could help researchers and clinicians to have a better comprehension of the importance of pre- and post-menopausal bone microenvironment and its clinical implications for precision medicine in cancer patients.
1）许多实体肿瘤存在骨转移，2）使用针对骨骼的治疗方法来减少骨转移，3）癌症治疗对生殖激素的影响，这些激素对正常的骨骼重塑维持至关重要。此外，由于卵巢性激素产生的下降和与绝经相关的炎症因子的增加，骨骼微环境进一步变得复杂，这导致骨丢失加速和骨质疏松症（OP）风险增加。同样，癌症和骨转移与性激素（特别是雌激素）密切相关。因此，这些发现提出了一个问题：先前存在的雌激素缺乏性 OP 是否会促进和/或影响癌细胞归巢和骨骼中的肿瘤生长？尽管存在一些临床前和临床证据，但必须了解这一方面，这在临床领域非常重要，医生需要了解可用的治疗方法，以降低癌症患者骨骼疾病的风险。本描述性系统综述总结了涉及先前存在的雌激素缺乏性 OP 与骨转移发展之间的双重相互作用的临床前和临床研究，并提供了支持健康和 OP 状态之间肿瘤生长和定植差异的证据。很少有研究评估雌激素缺乏性 OP 对骨转移易感性的影响。因此，实施生物学知识可以帮助研究人员和临床医生更好地理解绝经前和绝经后骨骼微环境的重要性及其对癌症患者精准医学的临床意义。
