「中华医学会成立110周年专栏」重新思考肿瘤

【中华医学会成立110周年专栏】重新思考肿瘤 正式在《中华肿瘤杂志》2025年第06期发表，中国科学报/科学网报道，欢迎广大读者阅读与下载。

文章链接

https://rs.yiigle.com/cmaid/1542702

https://pubmed.ncbi.nlm.nih.gov/40443342/

摘要

在过去半个世纪的全球抗癌斗争中，无论是肿瘤基础研究还是临床实践，几乎所有探索均围绕“体细胞突变”这一理论展开，比如在分子分型、个体化精准医学、基因治疗、新抗原肿瘤疫苗研发以及测序技术开发等诸多方面。即便近年备受瞩目的肿瘤微环境研究，包括肿瘤免疫方向，其最终归因仍往往指向癌细胞或微环境细胞中的某些特定基因和突变。然而，“体细胞突变”范式并未为临床带来真正有效的肿瘤治愈路径，倘若继续以该理论为主导框架，显然难以在肿瘤的理解与治疗上取得实质性进步。因此，在肿瘤研究史的这个关键十字路口，一场彻底的新思维变革迫在眉睫。文章阐述了肿瘤系统为理解肿瘤本质所带来的新视角，肿瘤生态学的基本原理及其在治疗中的潜在应用，并探讨了生态病理学这一新兴领域的理论框架与研究意义。呼吁要摒弃当前主导的肿瘤线性还原旧范式，更重要的是，致力于为后基因组时代的新肿瘤学和肿瘤生态哲学搭建一个切实可行且系统化的认知框架，以推动攻克恶性肿瘤这一社会目标。

ABSTRACT

Over the past half-century of the global effort against cancer, the vast majority of investigations in both tumor basic research and clinical practice have centered on the "somatic mutation" theory, such as in molecular classification, individualized precision medicine strategies, gene therapy approaches, the development of neoantigen-based tumor vaccines, and advancements in sequencing technologies. Even in the extensively studied tumor microenvironment (including tumor immunity), which has garnered significant attention in recent years, the underlying mechanisms frequently revert to specific genes and mutations within tumor cells or microenvironmental cells as the primary driving forces. However, despite the dominance of the "somatic mutation" paradigm, truly effective approaches for curing cancer in clinical settings remain elusive. Undoubtedly, if the prevailing "somatic mutation theory" continues to monopolize cancer research, meaningful progress in understanding and treating cancer will likely remain frustratingly out of reach. At this critical juncture in the evolution of cancer research, a comprehensive re-evaluation of cancer not only is necessary but also imperative, highlighting the urgent need for a profound transformation in our conceptual framework. This article systematically elucidates the novel perspective offered by the "tumor system" for comprehending the essence of cancer, the foundational principles of "tumor ecology" and their potential applications in treatment, and explores in depth the theoretical framework and research significance of the emerging field of "ecological pathology". Beyond merely advocating for the abandonment of the currently dominant linear reductionist paradigm of cancer, this commentary strives to construct a pragmatic and systematically structured framework to guide the trajectory of the "post-genomic revolution in oncology" and the "tumor ecological philosophy", ultimately fostering the realization of the overarching societal goal of eradicating cancer.