近日發(fā)表在美國(guó)癌癥協(xié)會(huì)同行評(píng)審雜志上的一項(xiàng)新研究發(fā)現(xiàn)，吸煙不僅會(huì)增加人們患膀胱癌的風(fēng)險(xiǎn)，還會(huì)影響腫瘤的發(fā)展過程，煙癮重的人群更容易出現(xiàn)病情惡化。此外，一系列膀胱癌標(biāo)記可幫助預(yù)測(cè)高風(fēng)險(xiǎn)病例。

　　眾所周知，吸煙是最常見的膀胱癌致病因素之一，而就吸煙是否會(huì)影響腫瘤的惡化過程是研究人員新的關(guān)注點(diǎn)。為了對(duì)此進(jìn)行調(diào)查研究，來自邁阿密大學(xué)米勒醫(yī)學(xué)院的Richard J. Cote博士和來自南加州大學(xué)凱克醫(yī)學(xué)院的Anirban Mitra博士領(lǐng)導(dǎo)的團(tuán)隊(duì)對(duì)212名不同種族的患者進(jìn)行了膀胱癌腫瘤和吸煙史方面的調(diào)查分析。

　　研究發(fā)現(xiàn)，在膀胱癌患者中，重度吸煙者比不吸煙者或輕度吸煙者更容易死于癌癥。此外研究還表明，一些特定的蛋白改變常常出現(xiàn)在嚴(yán)重的膀胱癌中。Mitra博士稱：“我們已經(jīng)識(shí)別出9種可準(zhǔn)確預(yù)測(cè)膀胱癌預(yù)后的分子標(biāo)記，這種預(yù)后不受常規(guī)臨床標(biāo)準(zhǔn)和吸煙史的影響。”如果患者的6至9種分子標(biāo)記出現(xiàn)改變，那么其預(yù)后就會(huì)很不樂觀，這意味著患者只能通過更高強(qiáng)度的治療來緩解病情。

　　由于這些蛋白改變的數(shù)量與患者的健康結(jié)果直接成正比，因此研究確定了一種這樣的理論，即在確定某個(gè)特定腫瘤的特征上，綜合分析各種標(biāo)記變化比只分析單一變化更重要。吸煙強(qiáng)度與患者預(yù)后之間的聯(lián)系證實(shí)，吸煙的危害會(huì)逐步積累，不斷擴(kuò)大。

　　邁阿密大學(xué)Cote博士稱：“這一研究發(fā)現(xiàn)具有非常強(qiáng)的臨床相關(guān)性，因?yàn)榘螂装┲委煹幕ㄙM(fèi)往往非常高，而目前的臨床分級(jí)很難準(zhǔn)確判斷具體患者的預(yù)后，患者急需相關(guān)的個(gè)性化疾病管理。”

　　Smoking intensity and cancer markers predict seriousness of bladder cancer

　　Smoking not only causes bladder cancer—it also affects its course, in that people who smoke more have greater likelihood of developing more aggressive and deadly disease. That is one of the conclusions of a new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society. The study also found that a panel of bladder cancer markers can predict which particular cases are at the highest risk for a fatal outcome.

　　Researchers have known that smoking is one of the most common causes of bladder cancer, but they’ve wondered whether it also affects how the disease progresses. To investigate, Richard J. Cote, MD, of the University of Miami Miller School of Medicine, and Anirban Mitra, MD, PhD, of the Keck School of Medicine of the University of Southern California, led a team that analyzed bladder tumors and smoking history in 212 multi-ethnic patients recruited through the Los Angeles County Cancer Surveillance Program between 1987 and 1996.

　　The researchers found that the bladder cancers that developed in individuals who smoked intensely were more likely to be deadly than bladder cancers that developed in those who never smoked, or who smoked less. The study also revealed that changes in particular proteins are often present in bladder cancers that have become deadly. “We have identified a panel of nine molecular markers that can robustly and reproducibly predict bladder cancer prognosis independent of standard clinical criteria and smoking history,” said Dr. Mitra. Patients with alterations in six to nine markers had a very poor outcome, raising the hypothesis that these individuals could have benefited from more aggressive treatments.

　　Because the number of changes in these proteins was directly proportional to patients’ health outcomes in a progressive fashion, the findings confirm the theory that an accumulation of changes is more important than individual changes in determining the characteristics of a given cancer. The link between smoking intensity and prognosis found in this study points to the incrementally harmful effects of smoking.

　　“The study’s findings are extremely clinically relevant as bladder cancer is one of the most expensive malignancies to treat,” said Dr. Cote, who is Director of the Genitourinary Malignancies Program at University of Miami’s Sylvester Comprehensive Cancer Center. “Personalized patient management is urgently needed for this disease as current clinical stratification cannot predict outcomes of individual patients.”