最近发表在cell杂志上的一个研究结果显示改变传统的癌症分类方式有助于提高癌症病人的诊断治疗，有治疗效率可以提高10%。
传统的癌症分类方式是根据组织来源进行分类，如乳腺癌、膀胱癌、肾癌等。但是一个组织是由多种细胞类型构成的。根据细胞及分子生物学特征进行分类可以提高诊断的精确性。
研究人员通过研究3500多个肿瘤样本，得出的显著性发现是膀胱癌和乳腺癌。他们将膀胱癌分成了3种以上的亚型，其中一种亚型几乎与一种非小细胞肺癌一样，其它的亚型与头颈鳞状细胞癌、肺癌相似。这个发现或许可以解释为什么在治疗一种癌症时，发生的非常不同的反应。
乳腺癌可以分为基底样细胞癌和导管癌，研究人员发现基底样乳腺癌可能来源于肾癌。
因此，新的癌症分类系统或许可以促进临床诊断和治疗。
Changes to the way cancers are classified could lead to more accurate diagnoses and perhaps more effective treatments in about one in 10 cancer patients, new research suggests.
Typically, cancers are categorized according to the tissue in which they originated, such as breast, bladder or kidney cancer. But tissues are composed of different types of cells.
In this study, researchers who analyzed more than 3,500 tumor samples of 12 different cancer types concluded that defining tumors by their cellular and molecular features, rather than by the tissues in which they originated, would improve diagnoses in about 10 percent of cancer cases.
“This genomic study not only challenges our existing system of classifying cancers based on tissue type, but also provides a massive new data resource for further exploration, as well as a comprehensive list of the molecular features distinguishing each of the newly described cancer classes,” study co-senior author Dr. Christopher Benz, professor at the Buck Institute for Research on Aging at the University of California, San Francisco, said in a university news release.
The study, published online Aug. 7 in the journal Cell, is part of The Cancer Genome Atlas initiative, which is led by the U.S. National Cancer Institute and U.S. National Human Genome Research Institute.
The researchers report particularly significant findings in bladder and breast cancers. They identified at least three different subtypes of bladder cancer, including one that was nearly identical to a form of non-small cell lung cancer called lung adenocarcinoma, and another most similar to squamous-cell cancers of the head and neck and of the lungs.
The findings may explain why bladder cancer patients “often respond very differently when treated with the same systemic therapy for their seemingly identical cancer type,” Benz said.
The researchers confirmed known differences between two forms of breast cancers called basal-like and luminal. But they also discovered that these differences are significant and that basal-like breast cancers — commonly referred to as triple-negative — are a distinct class of tumor.
“What’s amazing is that basal breast cancer is as different from luminal breast cancer as it is from, say, kidney cancer,” study co-lead author Denise Wolf, a research scientist based in UCSF’s Department of Laboratory Medicine, said in the news release.
Basal-like cancers are highly aggressive and more common among black and younger women.
“Even though these basal-like cancers arise in the breast, on the molecular level they have more in common with ovarian cancers and cancers of squamous-cell origin than with other subtypes of breast cancer,” explained study co-lead author Christina Yau, a staff scientist at the Buck Institute and assistant professor of surgery at UCSF.
“This is the first time ever you’ve been able to point to important molecular features shared by basal breast cancer, and by squamous head-and-neck cancer and lung cancer,” Wolf said.
“And the same is true of immune activation — we found that different cancer types have very similar immune signatures, a factor that may be relevant clinically with the rise of new immune therapies,” she added.
Further research could reveal that as many as 30 to 50 percent of cancers need to be reclassified, according to Benz.
“Although follow-up studies are needed to validate and refine this newly proposed cancer classification system, it will ultimately provide the biologic foundation for that era of personalized cancer treatment that patients and clinicians eagerly await,” Benz believes.