Proposal for a new model of breast cancer metastatic development
Proposal for a new model of breast cancer metastatic development
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DOI：
10.1023/a:1008263116022
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发表时间：
1997-11-01
影响因子：
50.5
通讯作者：
Bonadonna, G
中科院分区：
文献类型：
--
作者：
Demicheli, R;Retsky, MW;Bonadonna, G
背景资料：乳腺癌转移发展的普遍接受的理论假设从肿瘤种植到临床复发的记录，肿瘤持续生长。特别是，Gompertzian生长动力学是目前的理论基石，乳腺癌的自然史，并已被广泛用于规划treatment.Materials和方法：为了验证协议的研究结果和影响的持续增长模型，几篇发表的论文乳腺癌的自然史后，去除原发性肿瘤进行了审查。此外，有关转移生物学的动物模型的研究结果被认为是considered.Results：连续生长模型失败的重要方式后，这一关键的重新评价。作为一种替代，肿瘤休眠假说被认为提供了一个更合理的描述肿瘤复发。此外，原发性肿瘤切除被揭示为一个潜在的干扰因素，转移development.Conclusions：一个新的一般轮廓的转移发展的乳腺癌纳入肿瘤休眠在特定的微转移阶段，它们之间的随机过渡，并开始信号从手术微转移生长的设计。所提出的模型提出了新的观点，目前的化疗方案，新的治疗方法，旨在保持微转移处于休眠状态，为患者的整个生命，并仔细重新评估手术的时间内的多模式治疗可手术的乳腺癌。
Background: The commonly accepted theory of breast cancer metastatic development assumes continuous tumor growth from tumor seeding until documentation of clinical recurrence. In particular, Gompertzian growth kinetics is currently the theoretical cornerstone of the natural history of breast cancer, and has been widely utilized for planning treatments.Materials and methods: To verify agreement between findings and the implications of the continuous growth model, several published papers about the natural history of breast cancer after removal of the primary tumor were reviewed. Also, findings from animal models concerning metastasis biology were considered.Results: The continuous growth model failed in important ways upon this critical reappraisal. As an alternative, the tumor dormancy hypothesis was considered to provide a more reasonable description of tumor recurrence. Moreover, primary tumor removal was revealed as a potentially perturbing factor for metastasis development.Conclusions: A new general outline of metastatic development of breast cancer incorporating tumor dormancy in specific micrometastatic phases, stochastic transitions between them, and start signals from surgery for micrometastatic growth was designed. The proposed model suggests new views concerning scheduling of current chemotherapy, new treatment approaches aimed at keeping micrometastases in a dormant state for the patient's entire life, and the careful reappraisal of the timing of surgery within the multimodal treatment of operable breast cancer.