什么时候前列腺癌才是真正的癌症?

IF 9.9 1区 医学 Q1 ONCOLOGY JNCI Journal of the National Cancer Institute Pub Date : 2024-10-01 DOI:10.1093/jnci/djae200
Matthew R Cooperberg, Avery E Braun, Alejandro Berlin, Adam S Kibel, Scott E Eggener
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引用次数: 0

摘要

前列腺癌(PC)是全球癌症相关死亡的主要原因,每年的诊断人数远远多于死亡人数。最近的讨论对第 1 组(GG1)前列腺癌(PC)是否应被贴上 "癌症 "的标签提出了质疑,因为它具有不活跃的性质。为解决这一问题,一场国际研讨会召集了来自不同领域的利益相关者。我们总结了讨论的要点:尸检研究显示,GG1 在老年男性中非常常见,可能是衰老的一个正常方面。纯 GG1 没有转移能力。现代诊断方法侧重于检测更高级别疾病,明确规定如果不怀疑 GG 2 或更高级别疾病,则不进行活组织检查,因此 GG1 实际上已成为一种 "偶发瘤"。最近对前列腺切片进行的空间转录组学研究发现了一系列基因组变化--包括组织学上正常区域的恶性肿瘤特征性改变,因此完全根据传统病理结果来判定癌症似乎越来越武断,至少在某种程度上是如此。病理学家讨论了异质性和诊断难题,建议将 "尖锐湿疣肿瘤 "作为一种可能的替代标签。GG1 不应被视为 "正常",绝对需要持续的积极监测;如果没有癌症诊断,患者是否会坚持监测还是未知数。患者的观点强调了过度治疗的不利影响和癌症诊断的负担。各医疗保健系统对筛查和治疗的预期影响不尽相同,但许多人认为,如果 GG1(以及其他器官中不会引起症状或威胁生命的病变)被贴上 "癌症 "以外的标签,总的来说会大大改善公众健康。归根结底,我们的目标是降低 PC 死亡率,同时将过度诊断和过度治疗带来的危害降至最低。
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When is prostate cancer really cancer?

Prostate cancer (PC) is a major cause of cancer-related deaths worldwide, with far more diagnoses than deaths annually. Recent discussions have challenged whether Grade Group 1 (GG1) PC should be labeled "cancer" due to its indolent nature. To address this question, an international symposium convened stakeholders from various fields. We summarize key discussion points: autopsy studies reveal GG1 is so common in aging males as to be perhaps a normal aspect of aging. Pure GG1 has no capacity to metastasize. Modern diagnostic pathways focus on detecting higher-grade disease, explicitly omitting biopsy if GG 2 or higher is not suspected, so GG1 has effectively become an "incidentaloma." Recent spatial transcriptomics of prostate sections identifies a continuum of genomic changes-including alterations characteristic of malignancy in histologically normal regions, so the designation of cancer based entirely on conventional pathology findings increasingly seems arbitrary at least to an extent. Pathologists discussed heterogeneity and diagnostic challenges, suggesting "acinar neoplasm" as one possible alternative label. GG1 should not be considered "normal," and absolutely requires ongoing active surveillance; whether patients would adhere to surveillance absent a cancer diagnosis is unknown. Patient perspectives highlighted the adverse effects of overtreatment and the burden of a cancer diagnosis. The anticipated impact on screening and treatment varies across health-care systems, but many believe public health would on balance greatly improve if GG1-along with lesions in other organs with no capacity to cause symptoms or threaten life-were labeled something other than "cancer." Ultimately, our goal is to reduce PC mortality while minimizing harms associated with both overdiagnosis and overtreatment.

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来源期刊
CiteScore
17.00
自引率
2.90%
发文量
203
审稿时长
4-8 weeks
期刊介绍: The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.
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