CLINICAL-EVIDENCE FOR AND IMPLICATIONS OF THE MULTISTEP DEVELOPMENT OF PROSTATE-CANCER
CLINICAL-EVIDENCE FOR AND IMPLICATIONS OF THE MULTISTEP DEVELOPMENT OF PROSTATE-CANCER
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DOI：
10.1016/s0022-5347(17)40078-4
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发表时间：
1990-04-01
影响因子：
6.6
通讯作者：
ISAACS, JT
中科院分区：
文献类型：
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作者：
CARTER, HB;PIANTADOSI, S;ISAACS, JT
根据大量的实验和临床数据，很明显，一个正常细胞要发展为完全恶性的癌细胞，多次恶性事件是必要的。关于人类前列腺癌发生的一个关键问题是在老年男性前列腺中存在大量组织学上的癌症的临床意义。一种可能性是，这些组织学上的前列腺癌已经经历了产生临床表现的癌症所需的所有恶性事件，因此，只需要进一步的肿瘤生长就可以产生临床肿瘤。或者，这些组织学上的癌症可能经历了一些但不是产生临床疾病所需的全部事件，因此，尽管宿主寿命长，只要没有进一步的恶性变化，癌症将在临床上保持沉默。这一问题对前列腺癌的诊断、治疗和可能的预防具有重要的临床意义。临床观察和前列腺癌患病率与宿主年龄（时间）之间的数学关系支持这样一个事实，即除了生长外，组织学前列腺癌还需要进一步的恶性事件才能产生临床疾病。更好地了解前列腺癌发展的相关事件对于将来对这种疾病产生更大的影响是必要的。
Based upon a large body of experimental and clinical data, it is evident that multiple malignant events are necessary for a normal cell to given rise to a fully malignant cancer cell. A critical issue with regard to human prostatic carcinogenesis is the clinical significance of the large number of cancers that are present histologically in the elderly male prostate gland. A possibility is that these histological prostate cancers already have undergone all of the malignant events necessary to produce clinically manifest cancer and, thus, only further tumor growth is required to produce a clinical tumor. Alternatively, these histological cancers may have undergone some but not all of the events necessary to produce clinical disease and, therefore, despite host longevity the cancer will remain clinically silent as long as no further malignant changes occur. This issue has importance clinically with respect to the diagnosis, therapy and possible prevention of prostatic cancer. Clinical observations and the mathematical relationship between prostate cancer prevalence and host age (time) support the fact that, in addition to growth, histological prostate cancer requires further malignant events to produce clinical disease. A better understanding of the events involved in prostate cancer development will be necessary to have a greater impact on this disease in the future.