Tu Shi-Ming, Pisters Louis L
Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2021 Feb 7;13(4):660. doi: 10.3390/cancers13040660.
Germ cell tumor of the testis (TGCT) is a remarkably curable solid tumor even when it is widely metastatic and patently heterogeneous. It provides invaluable clues about the origin and nature of metastasis and heterogeneity, cancer dormancy and late recurrence, drug sensitivity and resistance, tumor immunity, and spontaneous remission that would enable us to enhance the cure and improve the care of patients with other currently intractable solid tumors. After all, germ cells are primeval stem cells and TGCT are a perfect stem cell tumor for us to investigate a stem cell versus genetic origin of cancer. In many respects, TGCT is a prototype stem cell tumor that will enable us to elucidate the role of differentiation versus dedifferentiation in the evolution of a complex mixed tumor. It will help us decipher relevance of the genome versus the epi-genome in a progenitor cancer stem cell versus a progeny differentiated cancer cell. Importantly, clarification of a cellular context versus the genetic makeup in cancer has immense clinical implications. We postulate a unified theory of cancer derived from seminal TGCT research to improve personalized cancer care. Contrary to current norms and conventional wisdom, we propose that when it concerns a complex rather than simple cancer and a mixed rather than pure tumor (which is practically all solid tumors) multimodal therapy trumps targeted therapy and integrated medicine overrides precision medicine.
睾丸生殖细胞肿瘤（TGCT）是一种即便广泛转移且明显异质性却仍具有显著可治愈性的实体瘤。它为转移和异质性的起源与本质、癌症休眠与晚期复发、药物敏感性与耐药性、肿瘤免疫以及自发缓解提供了宝贵线索，这些线索将使我们能够提高对其他目前难以治疗的实体瘤患者的治愈率并改善其护理。毕竟，生殖细胞是原始干细胞，而TGCT是我们研究癌症的干细胞起源与基因起源的理想干细胞肿瘤。在许多方面，TGCT是一种原型干细胞肿瘤，它将使我们能够阐明分化与去分化在复杂混合肿瘤演变中的作用。它将帮助我们解读在祖代癌症干细胞与子代分化癌细胞中基因组与表观基因组的相关性。重要的是，明确癌症中的细胞背景与基因组成具有巨大的临床意义。我们基于开创性的TGCT研究提出一种统一的癌症理论，以改善个性化癌症护理。与当前的规范和传统观念相反，我们提出，当涉及复杂而非简单的癌症以及混合而非纯粹的肿瘤（实际上所有实体瘤都是如此）时，多模式治疗胜过靶向治疗，整合医学优于精准医学。
