Sharma Karishma, Sayed Shahin, Saleh Mansoor
Clinical Research Unit, Aga Khan University Cancer Center, Aga Khan University, Nairobi, Kenya.
Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya.
Front Med (Lausanne). 2022 Jul 6;9:950309. doi: 10.3389/fmed.2022.950309. eCollection 2022.
Promoting best practice in the management of a cancer patient is rooted in the application of new knowledge derived through various sources including population science, laboratory advances, and translational research. Ultimately, the impact of these advances depends on their application at the patient's bedside. A close collaboration between the oncologist and the pathologist is critical in underwriting progress in the management of the cancer patient. Recent advancements have shown that more granular characteristics of the tumor and the microenvironment are defining determinants when it comes to disease course and overall outcome. Whereas, histologic features and basic immunohistochemical characterization were previously adequate to define the tumor and establish treatment recommendation, the growing capability of the pathologist to provide molecular characterization of the tumor and its microenvironment, as well as, the availability of novel therapeutic agents have revolutionized cancer treatment paradigms and improved patient-outcomes and survival. While such capacity and capability appear readily available in most developed high-income countries (HIC), it will take a concerted and collaborative effort of all stakeholders to pave the way in the same stride in the low and middle-income countries (LMIC), which bear a disproportionate burden of human illness and cancers. Patients in the LMIC present with disease at advanced stage and often display characteristics unlike those encountered in the developed world. To keep stride and avoid the disenfranchisement of patients in the LMIC will require greater participation of LMIC patients on the global clinical trial platform, and a more equitable and affordable sharing of diagnostic and therapeutic capabilities between the developed and developing world. Key to the success of this progress and improvement of patient outcomes in the developing world is the close collaboration between the oncologist and the pathologist in this new era of precision and personalized medicine.
推广癌症患者管理的最佳实践源于将通过包括群体科学、实验室进展和转化研究等各种来源获得的新知识加以应用。最终，这些进展的影响取决于它们在患者床边的应用。肿瘤学家和病理学家之间的密切合作对于确保癌症患者管理取得进展至关重要。最近的进展表明，肿瘤和微环境的更细化特征在疾病进程和总体结果方面起着决定性作用。虽然组织学特征和基本免疫组化特征以前足以定义肿瘤并确定治疗建议，但病理学家提供肿瘤及其微环境分子特征的能力不断提高，以及新型治疗药物的出现，彻底改变了癌症治疗模式，改善了患者预后和生存率。虽然这种能力在大多数发达的高收入国家似乎 readily available，但在低收入和中等收入国家（这些国家承担着不成比例的人类疾病和癌症负担），所有利益相关者需要共同努力，才能在同一进程中取得进展。低收入和中等收入国家的患者往往在疾病晚期就诊，其表现出的特征与发达国家所见的不同。要跟上步伐并避免低收入和中等收入国家的患者被剥夺权益，就需要低收入和中等收入国家的患者更多地参与全球临床试验平台，并在发达国家和发展中国家之间更公平、更实惠地共享诊断和治疗能力。在这个精准和个性化医疗的新时代，肿瘤学家和病理学家之间的密切合作是发展中国家取得这一进展并改善患者预后的关键。
