【medical-news】新英格兰医学杂志：基因标记物可预测肝癌的晚期复发
发布于 2008-10-25 · 浏览 1849 · IP 北京北京
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October 17, 2008 — Patients with liver cancer in the developed world are often diagnosed when the tumor is small, so treatment is likely to be successful. Despite this, most patients go on to have recurrences, and in many cases where the primary tumor is found at an early stage and is resected, the recurrence appears late, 2 years or more after resection.
A new study shows that a certain gene-expression signature found in the liver tissue adjacent to the primary tumor can predict such a late recurrence. The results also suggest that these late recurrences are in fact new primary tumors arising in a damaged organ (from the so-called "field effect"), rather than arising from residual tumors cells from the original primary tumor, the researchers comment.
The findings were published online October 15 in the New England Journal of Medicine. First author Yujin Hoshida, MD, PhD, from the Massachusetts Institute of Technology and Harvard University, in Cambridge, collaborated with other centers in the United States, and centers in Japan, Italy, Norway, and Spain.
"Our results suggest that a gene-expression signature can serve as a sensitive 'read-out' of the biological state of the liver in at-risk patients," the researchers write. "It is likely that the survival signature reflects the extent of liver damage and the presence and absence of a proinflammatory milieu, which is mediated in part by gene products involved in an inflammatory response." They add, however, that a heritable basis for the signature, although improbable, cannot be ruled out.
This finding has "direct implications for the prediction of survival and late recurrence after resection for hepatocellular carcinoma," comments Morris Sherman, MB, BCh, PhD, from the department of medicine at Toronto University, in Ontario, in an accompanying editorial.
Dr. Sherman agrees that this finding might make it possible to apply more intense prevention interventions for patients who carry the recurrence signature. "This approach makes sense, although it is hard to see what more can be done for those patients than is done already."
It us hard to see what more can be done for those patients than is done already.
Patients with hepatocellular carcinoma are already carefully monitored and continue to undergo surveillance indefinitely after resection, he points out. Chemoprevention has been explored in such patients but "is not yet practical."
"Perhaps the only realistic method for improving outcome in these patients might be to offer liver transplantation, thereby removing the field defect," he comments. But although liver transplantation is a recognized therapy for hepatocellular carcinoma, it is not currently offered to those who undergo hepatic resection as the first-line therapy, he notes.
The researchers have disclosed no relevant financial relationships. Dr. Sherman reports receiving consulting fees, lecture fees and grant support from Bayer, and consulting fees from Bristol-Myers Squibb.
N Engl J Med. Published online October 15, 2008. Abstract
A new study shows that a certain gene-expression signature found in the liver tissue adjacent to the primary tumor can predict such a late recurrence. The results also suggest that these late recurrences are in fact new primary tumors arising in a damaged organ (from the so-called "field effect"), rather than arising from residual tumors cells from the original primary tumor, the researchers comment.
The findings were published online October 15 in the New England Journal of Medicine. First author Yujin Hoshida, MD, PhD, from the Massachusetts Institute of Technology and Harvard University, in Cambridge, collaborated with other centers in the United States, and centers in Japan, Italy, Norway, and Spain.
"Our results suggest that a gene-expression signature can serve as a sensitive 'read-out' of the biological state of the liver in at-risk patients," the researchers write. "It is likely that the survival signature reflects the extent of liver damage and the presence and absence of a proinflammatory milieu, which is mediated in part by gene products involved in an inflammatory response." They add, however, that a heritable basis for the signature, although improbable, cannot be ruled out.
This finding has "direct implications for the prediction of survival and late recurrence after resection for hepatocellular carcinoma," comments Morris Sherman, MB, BCh, PhD, from the department of medicine at Toronto University, in Ontario, in an accompanying editorial.
Dr. Sherman agrees that this finding might make it possible to apply more intense prevention interventions for patients who carry the recurrence signature. "This approach makes sense, although it is hard to see what more can be done for those patients than is done already."
It us hard to see what more can be done for those patients than is done already.
Patients with hepatocellular carcinoma are already carefully monitored and continue to undergo surveillance indefinitely after resection, he points out. Chemoprevention has been explored in such patients but "is not yet practical."
"Perhaps the only realistic method for improving outcome in these patients might be to offer liver transplantation, thereby removing the field defect," he comments. But although liver transplantation is a recognized therapy for hepatocellular carcinoma, it is not currently offered to those who undergo hepatic resection as the first-line therapy, he notes.
The researchers have disclosed no relevant financial relationships. Dr. Sherman reports receiving consulting fees, lecture fees and grant support from Bayer, and consulting fees from Bristol-Myers Squibb.
N Engl J Med. Published online October 15, 2008. Abstract
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