Macciò Antonio, Madeddu Clelia
Gynecology and Gynecologic Oncology Unit, Department of Oncological Surgery-ARNAS G. Brotzu; Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, Italy.
Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy.
Transl Oncol. 2025 Jan;51:102162. doi: 10.1016/j.tranon.2024.102162. Epub 2024 Oct 28.
In a recent article titled "Embracing Cancer Complexity: Hallmarks of Systemic Disease" published in Cell, Swaton et al. propose the idea of cancer as a guest that develops within a host. They discuss the possible causes and events of neoplastic cell dysregulations within an organism, highlighting events such as cachexia and thrombosis. However, we believe that to understand cancer-associated phenomena better, cancer cannot be considered a guest. In reality, cancer is born, develops, and spreads within its environment. It does not come from outside but instead uses the same system in which it lives to promote its death plan. Indeed, today we know that cancer not only causes local symptoms in the affected organ but also leads to systemic symptoms, which are evidence of inflammation associated with cancer. Inflammation is vital in controlling oncogenesis and neoplastic proliferation during the resistance phase, which is a critical moment for the immune system to demonstrate its effectiveness. However, if the immune system causes immunopathological damage, it may lead to necrosis and eventually to the tolerance phase, which can result in systemic symptoms. Understanding these phenomena thoroughly explains thrombophilia, anemia, sarcopenia, and iron metabolism disruption in advanced-stage neoplastic patients. The concept of the microenvironment takes on a different meaning in this context. The same cells that should oppose cancer in the tolerance phase now participate in a process that self-maintains, favoring the growth of the cancer and its death plan. The exact knowledge of these mechanisms is a more modern translational approach to treating cancer and its related symptoms.
在发表于《细胞》杂志的一篇题为《拥抱癌症复杂性:全身性疾病的特征》的近期文章中,斯瓦顿等人提出癌症是在宿主内发展起来的“客人”这一观点。他们讨论了生物体内肿瘤细胞失调的可能原因和事件,强调了恶病质和血栓形成等事件。然而,我们认为,为了更好地理解与癌症相关的现象,不能将癌症视为客人。实际上,癌症在其所处环境中诞生、发展和扩散。它并非来自外部,而是利用其生存的同一系统来推进其“死亡计划”。的确,如今我们知道癌症不仅会在受影响器官引发局部症状,还会导致全身症状,这些症状是与癌症相关炎症的证据。炎症在抵抗阶段对控制肿瘤发生和肿瘤增殖至关重要,这是免疫系统展示其有效性的关键时刻。然而,如果免疫系统造成免疫病理损伤,可能会导致坏死并最终进入耐受阶段,这可能会引发全身症状。透彻理解这些现象就能解释晚期肿瘤患者的血栓形成倾向、贫血、肌肉减少症和铁代谢紊乱。在这种情况下,微环境的概念具有不同的意义。在耐受阶段本应对抗癌症的相同细胞,现在却参与到一个自我维持的过程中,这有利于癌症的生长及其“死亡计划”。对这些机制的确切了解是治疗癌症及其相关症状的一种更现代的转化方法。