Khuri F R, Lippman S M, Spitz M R, Lotan R, Hong W K
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
J Natl Cancer Inst. 1997 Feb 5;89(3):199-211. doi: 10.1093/jnci/89.3.199.
Head and neck cancer is a major worldwide health problem; it has been estimated that approximately 900,000 people were diagnosed with this disease in 1995. Patients are generally treated with surgery and/or radiation therapy. Treatment, especially of patients with early stage (I or II) head and neck squamous cell carcinoma, is often successful. A serious concern, however, is the fact that these patients subsequently develop second primary tumors at an annual rate of 4%-7%. Molecular analyses of premalignant and malignant tissues have produced strong evidence that clonal genetic alterations occur during the early stage of aerodigestive tract carcinogenesis. Although the roles of tobacco and diet in head and neck carcinogenesis have been the subjects of epidemiologic investigations for many years, it has only recently become possible to integrate information regarding genetic susceptibility factors into the development of comprehensive risk models for these cancers. The molecular and epidemiologic studies provide the foundation on which clinical trials can be designed to evaluate the role of retinoids and other compounds in the reversal of premalignancy and the prevention of second primary tumors (i.e., in chemoprevention). This translational approach has led to studies of the utility of intermediate end point markers, such as the nuclear retinoic acid receptors, in chemoprevention strategies. Given the rapid advances occurring in this area of research, it may soon be possible to use these biomarkers to identify patients who are most at risk for developing head and neck cancer and who are most likely to benefit from chemopreventive interventions.
头颈癌是一个全球性的重大健康问题；据估计，1995年约有90万人被诊断患有这种疾病。患者通常接受手术和/或放射治疗。治疗，尤其是对早期（I期或II期）头颈鳞状细胞癌患者的治疗，往往是成功的。然而，一个严重的问题是，这些患者随后每年会以4%-7%的比率发生第二原发性肿瘤。对癌前组织和恶性组织的分子分析已产生有力证据，表明在呼吸道消化道癌变的早期阶段会发生克隆性基因改变。尽管烟草和饮食在头颈癌发生中的作用多年来一直是流行病学调查的主题，但直到最近才有可能将有关遗传易感性因素的信息纳入这些癌症综合风险模型的开发中。分子和流行病学研究为设计临床试验提供了基础，以评估视黄酸和其他化合物在逆转癌前病变和预防第二原发性肿瘤（即化学预防）中的作用。这种转化方法已导致对中间终点标志物（如核视黄酸受体）在化学预防策略中的效用进行研究。鉴于该研究领域的快速进展，也许很快就可以使用这些生物标志物来识别最易患头颈癌且最可能从化学预防干预中受益的患者。
