No clear answers on safety of pigs as tissue donor source
No clear answers on safety of pigs as tissue donor source
复制标题
DOI：
10.1016/s0140-6736(98)22035-6
复制
发表时间：
1998-08
期刊：
影响因子：
--
通讯作者：
J. Stoye
中科院分区：
文献类型：
--
作者：
J. Stoye
请参阅第 682 页 对儿童癌症的研究对肿瘤学实践的影响比潜在挽救生命的数量所显示的影响更广泛。神经母细胞瘤是第一种被发现基因改变具有预后重要性的癌症，1 就是一个很好的例子。这种胚胎肿瘤的治疗进展充其量是有限的。 2 从分子学到流行病学，人们付出了大量努力来解开神经母细胞瘤的谜团。后一类研究的一个例子可以在今天的《柳叶刀》中找到，朱迪思·鲍威尔（Judith Powell）及其同事的报告称，英国神经母细胞瘤的诊断晚于其他欧洲国家。这种延迟可能是由于在出生后第一年进行的儿童健康检查较少，与英国的疾病发病率显着降低、年龄较大的儿童转移性疾病过多以及总体死亡率较高有关。有令人信服的证据表明神经母细胞瘤是一种异质性疾病，代表至少两种不同的临床/生物学实体。 3, 4 大约一半的儿童在年轻时或早期就出现（参见小组的生物学差异），尽管不接受治疗或接受最低限度的治疗，但仍具有良好的临床预后。 3, 5 在 6 个月或更小的时候筛查神经母细胞瘤会增加有利预后疾病的检出率，6, 7 神经母细胞瘤发病率增加是未筛查人群的两倍以上。与临床检测到的 IV-S 期（特殊）疾病一样，8 相当一部分婴儿神经母细胞瘤必须在临床检测前自发消退。此外，在 6 个月或更小的时候进行筛查似乎并不能降低总体死亡率。 7 另外 50% 左右的神经母细胞瘤患者在 1 岁后被诊断出来，通常已处于晚期疾病，尽管进行了包括骨髓移植在内的积极治疗，但结果仍很差。 2–4 从预后角度来看，不利的生物学指标（面板）似乎比年龄或分期更重要。婴儿筛查计划很少能检测到具有低风险特征的肿瘤，6, 7 即使检测到，它们也可能继续危及生命。少数人患有混合生物学疾病（例如，未扩增的 MYCN 和低 trk-A 表达），预后中等。 4
See page 682 Research into the childhood cancers has had a wider impact on oncology practice than the number of potential lives saved would suggest. Neuroblastoma, the first cancer in which genetic alterations were found to have prognostic importance, 1 is an excellent example. Treatment advances in this embryonal neoplasm have been at best modest. 2 Much effort, from the molecular to the epidemiological, has been put into unravelling the mysteries of neuroblastoma. An example of the latter type of research can be found in today’s Lancet, in Judith Powell and colleagues’ report that neuroblastoma is diagnosed later in the UK than in other European countries. This delay, possibly due to fewer hands-on child-health examinations in the first year of life, is associated with a significantly lower incidence of the disease in the UK, an excess of metastatic disease in older children, and a higher overall mortality rate. There is compelling evidence that neuroblastoma is a heterogeneous disease representing at least two distinct clinical/biological entities. 3, 4 About half of all children present at a young age or early stage (see panel for biological differences) and have an excellent clinical prognosis despite no or minimum therapy. 3, 5 Screening for neuroblastoma at 6 months or younger increases the detection rate of favourable-prognosis disease, 6, 7 with an increase in neuroblastoma incidence that is more than twice that among non-screened populations. As with clinically detected stage IV-S (for special) disease, 8 a substantial fraction of infant neuroblastomas must spontaneously regress before clinical detection. Furthermore, screening at age 6 months or less does not seem to reduce overall mortality. 7 The other 50% or so of patients, who present with neuroblastoma, are diagnosed after the age of 1 year, commonly with advanced disease, and have a poor outcome despite aggressive therapy, including bone-marrow transplantation. 2–4 Prognostically, unfavourable biological indices (panel) seem more important than age or stage. Few, if any, tumours with poor-risk features are detected by infant screening programmes, 6, 7 and they would probably continue to be life-threatening even if they were. A minority have mixed-biology disease (eg, nonamplified MYCN and low trk-A expression) with an intermediate prognosis. 4