重新思考未知的原发性癌症:从诊断挑战到向治疗
Maria Pouyiourou1,2, Tilmann Bochtler1,2,3, Chantal Pauli4,5
1Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
Nature reviews. Clinical oncology
|August 4, 2025
概括
分子导向治疗改善了未知的初级 (CUP) 癌症患者的癌症结局,具有可操作的目标. 新的策略和免疫疗法显示出改善这种具有挑战性的恶性瘤的生存率的希望.
科学领域:
- 在瘤学瘤学.
- 基因组学就是基因组学.
- 精准医学是一门精准的医学.
背景情况:
- 未知原发性癌症 (CUP) 占所有恶性瘤的1-3%,尽管接受标准化疗,但不良预后 (<1年中位生存率) 的不利子组占所有恶性瘤的1-3%.
- 在过去的几十年中,了解CUP生物学或改善患者结果的进展很少,最初的试验未能验证用于组织起源 (ToO) 识别的基因表达特征.
研究的目的:
- 审查CUP目前的ToO方法.
- 为了比较初级瘤部位导向与组织学不可知治疗方法的CUP.
- 讨论CUP作为组织学不可知精度瘤学的模型.
主要方法:
- 大队列随机试验和非随机II期试验的综述.
- 分析新的ToO识别策略,包括DNA/RNA测序,DNA甲基化分析,ctDNA分析和基于AI的病理学.
- 对初级部位导向与组织学不可知管理的证据的比较.
主要成果:
- 大型队列试验表明,对具有可操作目标的CUP患者进行分子导向治疗可以改善结果.
- 使用免疫检查点抑制剂的免疫疗法在复发性或耐火性CUP中显示出潜在的益处.
- 先进的分子和计算技术正在增强ToO识别.
结论:
- 分子导向疗法和免疫疗法在CUP管理方面取得了重大进展.
- 精细的TOO识别方法对于个性化治疗策略至关重要.
- CUP 作为开发组织学不可知精度瘤学治疗的有价值模型.
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