肾细胞癌的预后标志物

摘要(中文译文)

本文综述了肾细胞癌预后标志物的近期报道。将更大规模患者队列纳入研究后，整合的病理学标志物提供了更有价值的预后信息；研究结果提示，有必要对TNM（肿瘤-淋巴结-转移）系统进行调整。多种与患者相关的因素在预后中仍然重要，包括体能状态、C反应蛋白和血小板增多症，此外还有免疫学因素（例如肾细胞癌表达B7-H1与疾病进展相关）。更多预后信息可能来自一系列分子标志物。基因芯片和甲基化研究的结果可能提供独立的预后信息。对信号通路认识的加深有助于更好地理解其潜在生物学机制并预测治疗反应。据报道，其他参与调控缺氧诱导因子的基因[例如编码碳酸酐酶-IX和PTEN（磷酸酶及张力蛋白同源物）的基因]在肾细胞癌中具有重要预后意义。其他标志物可独立预测生存（例如胸苷磷酸化酶和survivin）。临床研究提示的分子标志物潜力令人鼓舞。对多种通路的认识将有助于建立可预测个体治疗反应的生物标志物体系。有用的生物标志物可能具有作为治疗靶点的潜力。

Abstract

This article reviews recent reports on prognostic markers in renal cell carcinoma. Inclusion in studies of larger cohorts of patients has yielded enhanced prognostic information from integrated pathological markers; the findings suggest that adjustment to the TNM (tumour-node-metastasis) system is warranted. A number of patient-related factors remain important prognostically, including performance status, C-reactive protein and thrombocytosis, but also immunological factors (e.g. expression of B7-H1 by renal cell carcinomas is associated with progression). Additional prognostic information may be derived from a range of molecular markers. Findings of gene array and methylation studies may yield independent prognostic information. Enhanced knowledge of signalling pathways has facilitated better understanding of underlying biology and prediction of response to treatment. Other genes involved in regulating hypoxia-inducible factor [e.g. genes encoding carbonic anhydrase-IX and PTEN (phosphatase and tensin homolog)] were reported to be prognostically important in renal cell carcinoma. Other markers independently predicted survival (e.g. thymidine-phosphorylase and survivin). The potential of molecular markers suggested by clinical research is encouraging. Knowledge of various pathways will facilitate creation of systems of biomarkers that are predictive of individual response to therapy. Useful biomarkers may have potential as therapeutic targets.

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