Peckham M
British Postgraduate Medical Federation, London, UK.
Ciba Found Symp. 1988;141:223-43. doi: 10.1002/9780470513736.ch13.
In the short term the major hope for reducing cancer mortality is to effect a reduction in the number of patients who develop malignant disease and in the proportion of cancer patients who present with metastases. Hitherto the major emphasis of clinical research on metastases has been directed at detection and elimination rather than prevention or early diagnosis. Extensive data relating histological class and tumour stage to risk of metastasis and metastatic pattern have been compiled from studies of relapse and from invasive and non-invasive staging procedures. However, the biological events involved in the metastatic process and the factors which influence it in relation to the natural history of primary human tumours are poorly understood. Information describing metastatic heterogeneity in individual patients, in terms of therapeutic response or intrinsic sensitivity to cytotoxic agents, is scanty. Similarly, the characteristics of human metastases in relation to the clonal heterogeneity of primary tumours are poorly defined. The clinical application of molecular biological techniques, which has led to the association of gene amplification with tumour behaviour in a range of sites, offers the prospects of improved tumour localization and therapy and, in the longer term, of tumour control by interventions based on a knowledge of the mechanisms that regulate cell growth and differentiation.
短期内，降低癌症死亡率的主要希望在于减少患恶性疾病的患者数量以及减少出现转移的癌症患者比例。迄今为止，临床研究对转移的主要重点一直放在检测和消除上，而非预防或早期诊断。通过对复发的研究以及侵入性和非侵入性分期程序，已经收集了大量有关组织学类型和肿瘤分期与转移风险及转移模式的相关数据。然而，人们对转移过程中涉及的生物学事件以及与原发性人类肿瘤自然史相关的影响因素了解甚少。关于个体患者在治疗反应或对细胞毒性药物的内在敏感性方面的转移异质性的信息很少。同样，人类转移灶与原发性肿瘤克隆异质性相关的特征也定义不清。分子生物学技术的临床应用已使基因扩增与一系列部位的肿瘤行为相关联，这为改善肿瘤定位和治疗提供了前景，从长远来看，也为基于对调节细胞生长和分化机制的了解进行干预来控制肿瘤提供了前景。
