Clark W H
Department of Pathology, Harvard Medical School, Beth Israel Hospital, Boston, MA 02215.
Acta Oncol. 1995;34(1):3-21. doi: 10.3109/02841869509093632.
The aberrant forms of life, neoplasia and cancer, are discussed under the events at the beginning of neoplasia and under five classes of neoplastic lesions. The lesional classes are: 1) The precursor state; 2) Intermediate lesions; 3) Primary cancer; 4) Metastasis; and 5) Metastasis from metastasis. The events at the beginning are a diverse group of agents and mechanisms that induce the lesions of the precursor state, not cancer. The lesions and events produced by induction are similar regardless of the agent. Thus, there must be similar biological principles and mechanisms operative in different neoplastic systems. The classes of neoplastic lesions and cancer are described and a theory derived therefrom. The theory is: Any perturbation that alters a cell or group of cells and their stroma so that they no longer respond appropriately to the forces of tissue, organ, and organismal maintenance, may induce a neoplastic system. The sequential progression of lesions of the induced neoplastic system is the result of a successive series of flaws in the continuum of reciprocal interactions between a group of cells and their stroma. The flaws, appearing seriatim, produce progressive (self)-disorganization of the lesions and progressive loss of response to the forces of tissue and organ maintenance.
异常的生命形式,即瘤形成和癌症,将在瘤形成起始阶段的相关事件以及五类肿瘤性病变的框架下进行讨论。这些病变类别包括:1)前驱状态;2)中间性病变;3)原发性癌症;4)转移;以及5)继发转移。起始阶段的事件是一组多样的因素和机制,它们诱发的是前驱状态的病变,而非癌症。无论诱发因素是什么,诱导产生的病变和事件都是相似的。因此,在不同的肿瘤系统中必然存在相似的生物学原理和机制。文中描述了肿瘤性病变和癌症的类别,并从中推导出一个理论。该理论为:任何改变细胞或一组细胞及其基质,使其不再对组织、器官和机体维持的力量做出适当反应的扰动,都可能诱发一个肿瘤系统。诱导产生的肿瘤系统中病变的相继进展,是一组细胞与其基质之间相互作用连续体中一系列相继出现的缺陷所致。这些缺陷依次出现,导致病变进行性(自身)紊乱,并逐渐丧失对组织和器官维持力量的反应。