Yorke E D, Fuks Z, Norton L, Whitmore W, Ling C C
Division of Radiation Oncology and Biophysics, George Washington University Medical Center, Washington, DC 20037.
Cancer Res. 1993 Jul 1;53(13):2987-93.
For many types of cancer, patients who relapse locally following localized treatment such as surgery or radiation therapy are found to have a higher incidence of distant metastases than those who are locally controlled. In this study we developed a mathematical model to investigate whether the excess distant metastases arise mainly from the local recurrence or whether the primary tumors in this group of patients have an intrinsically higher metastatic potential than those of locally controlled patients of the same clinical stage. The parameters of the model were chosen to be representative of prostate cancer and the calculated results were compared with published clinical data for carcinoma of the prostate. The best agreement with the data was seen for parameters which imply somewhat more "aggressive" primary tumors for locally relapsing patients, yielding relatively high rates of micrometastatic dissemination prior to initial diagnosis. However, the model calculations indicate that more than half of the metastases in such patients originated in association with the development of a local recurrence. Therefore, achieving local control in this group of patients would be beneficial in improving long term survival.
对于许多类型的癌症，接受手术或放射治疗等局部治疗后出现局部复发的患者，其远处转移的发生率高于局部得到控制的患者。在本研究中，我们建立了一个数学模型，以调查远处转移增加主要是源于局部复发，还是这组患者的原发性肿瘤比处于相同临床分期且局部得到控制的患者具有更高的内在转移潜能。模型参数的选择代表前列腺癌，并将计算结果与已发表的前列腺癌临床数据进行比较。对于那些表明局部复发患者的原发性肿瘤更具“侵袭性”的参数，与数据的一致性最佳，这会在初次诊断前产生相对较高的微转移播散率。然而，模型计算表明，这类患者中超过一半的转移是在局部复发过程中发生的。因此，使这组患者实现局部控制将有助于提高长期生存率。
