Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstrasse 24, 89075, Ulm, Germany.
Department of Radiology, German Armed Forces Hospital of Ulm, Ulm, Germany.
Cancer Metastasis Rev. 2019 Dec;38(4):673-682. doi: 10.1007/s10555-019-09836-y.
Cancer is a leading cause of death in both adults and children, but in terms of absolute numbers, pediatric cancer is a relatively rare disease. The rarity of pediatric cancer is consistent with our current understanding of how adult malignancies form, emphasizing the view of cancer as a genetic disease caused by the accumulation and selection of unrepaired mutations over time. However, considering those children who develop cancer merely as stochastically "unlucky" does not fully explain the underlying aetiology, which is distinct from that observed in adults. Here, we discuss the differences in cancer genetics, distribution, and microenvironment between adult and pediatric cancers and argue that pediatric tumours need to be seen as a distinct subset with their own distinct therapeutic challenges. While in adults, the benefit of any treatment should outweigh mostly short-term complications, potential long-term effects have a much stronger impact in children. In addition, clinical trials must cope with low participant numbers when evaluating novel treatment strategies, which need to address the specific requirements of children.
癌症是导致成人和儿童死亡的主要原因，但就绝对数量而言，儿童癌症是一种相对罕见的疾病。儿童癌症的罕见性与我们目前对成人恶性肿瘤形成方式的理解一致，强调了癌症是一种遗传疾病，是随着时间的推移，未修复的突变积累和选择导致的。然而，仅仅将那些患上癌症的儿童视为随机的“不幸者”并不能完全解释其潜在的病因，这与成年人观察到的病因不同。在这里，我们讨论了成人和儿童癌症在癌症遗传学、分布和微环境方面的差异，并认为儿科肿瘤需要被视为一个具有独特治疗挑战的独特亚组。虽然在成年人中，任何治疗的益处都应超过短期并发症，但潜在的长期影响对儿童的影响要大得多。此外，临床试验在评估新的治疗策略时必须应对低参与者数量的问题，这需要满足儿童的特殊需求。
