癌症干细胞的临床影响。

The Clinical Impact of Cancer Stem Cells.

机构信息

Cancer Impact Area, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Department of Pharmacology and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

出版信息

Oncologist. 2020 Feb;25(2):123-131. doi: 10.1634/theoncologist.2019-0517. Epub 2019 Dec 17.

Abstract

Patients with cancer can go though many stages in their disease, including diagnosis, recurrence, metastasis, and treatment failure. Cancer stem cells (CSCs) are a subgroup of cells within tumors that may explain the mechanism by which tumors recur and progress. CSCs can both self-renew and produce progenitor cells of more differentiated cancer cells as well as heterogeneously demonstrate resistance and the abilities to migrate and metastasize. These "stemness" characteristics are often the result of dysregulation of one or more pathways, which can be detected by various biomarkers. Although there has been considerable laboratory research conducted on CSCs, its relevance to the practicing oncologist may seem questionable. We sought to determine the clinical impact of CSCs on patients. A systematic literature search was conducted to identify analyses containing survival information based on the expression of known CSC biomarkers in any cancer. Overall, 234 survival analyses were identified, of which 82% reported that high expression of CSC biomarker(s) resulted in poor overall survival and/or disease-free survival compared with low or no expression of the biomarker. Elevated stemness biomarker levels were also associated with decreased tumor differentiation, altered TNM stage, and increased metastasis. This analysis would suggest that CSCs have a clinical impact on patients and that practicing oncologists need to start considering incorporating CSC-targeting therapies into their patients' treatment regimens. IMPLICATIONS FOR PRACTICE: Cancer stem cells (CSCs) may occur at any stage of cancer and are implicated in the occurrence of resistance, recurrence, and metastasis. A systematic literature analysis has shown that the presence of CSCs, identified via the upregulation of stemness pathway biomarkers, results in reduced survival across all cancers studied. Several CSC-targeting agents are currently approved, and several others are in clinical trials. Future treatment regimens will likely include CSC-targeting agents to enable the elimination of these holdouts to current therapies.

摘要

癌症患者在疾病过程中可能会经历多个阶段,包括诊断、复发、转移和治疗失败。癌症干细胞 (CSC) 是肿瘤内的一组细胞亚群,可能解释了肿瘤复发和进展的机制。CSC 既能自我更新,又能产生更分化的癌细胞的祖细胞,并且具有异质性的耐药性以及迁移和转移的能力。这些“干性”特征通常是一个或多个途径失调的结果,可以通过各种生物标志物检测到。尽管已经对 CSC 进行了大量的实验室研究,但它与执业肿瘤学家的相关性似乎值得怀疑。我们试图确定 CSC 对患者的临床影响。进行了系统的文献检索,以确定基于任何癌症中已知 CSC 生物标志物表达的包含生存信息的分析。总体而言,确定了 234 项生存分析,其中 82%的分析报告称,与生物标志物低表达或不表达相比,CSC 生物标志物高表达导致总生存率和/或无病生存率降低。升高的干细胞标志物水平也与肿瘤分化程度降低、TNM 分期改变和转移增加有关。这项分析表明,CSC 对患者具有临床影响,执业肿瘤学家需要开始考虑将 CSC 靶向治疗纳入患者的治疗方案。

实践意义

癌症干细胞 (CSC) 可能出现在癌症的任何阶段,并与耐药性、复发和转移的发生有关。系统的文献分析表明,通过上调干性途径生物标志物鉴定的 CSC 的存在会导致所有研究癌症的生存率降低。目前有几种 CSC 靶向药物获得批准,还有几种正在临床试验中。未来的治疗方案可能包括 CSC 靶向药物,以消除这些对现有治疗方法的阻碍。

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