早期肺腺癌的瘤内异质性

肺癌是世界上最致命的疾病之一，也是癌症相关死亡的主要原因。在组织学类型中，腺癌是最常见的，其特点是在临床、行为、细胞和分子水平上具有高度的异质性。虽然大多数肺癌都以其侵袭性行为而闻名，但CT筛查发现的肺癌中，高达18.5%的肺癌为惰性病程，使患者面临过度诊断和过度治疗的风险。肿瘤行为的细胞和分子基础仍不清楚。近年来，研究肿瘤内部异质性已成为了解肿瘤进展的一个有吸引力的策略。这篇综述将总结一些目前已知的肺腺癌行为的决定因素，并讨论近期研究其瘤内异质性的工作。

Lung cancer is one of the deadliest diseases in the world and is the leading cause of cancer-related deaths. Among the histological types, adenocarcinoma is the most common, and it is characterized by a high degree of heterogeneity at many levels including clinical, behavioral, cellular and molecular. While most lung cancers are known for their aggressive behavior, up to 18.5% of lung cancers detected by CT screening are indolent and put patients at risk for overdiagnosis and overtreatment. The cellular and molecular underpinnings of tumor behavior remain largely unknown. In the recent years, the study of intratumor heterogeneity has become an attractive strategy to understand tumor progression. This review will summarize some of the current known determinants of lung adenocarcinoma behavior and discuss recent efforts to dissect its intratumor heterogeneity

在过去的几十年里，已经做出了一些努力来降低肺癌患者的死亡率。虽然在诊断和治疗方面取得了进展，但与其他癌症相比，长期生存率几乎没有提高（1）。因此，需要新的方法。对于肺腺癌（ADC）是非常重要的，因为其过度诊断率高，预测肿瘤的惰性和侵袭性行为缺乏准确性（2）。为了更好地预测疾病行为，了解肿瘤的细胞和分子基础至关重要。因此，研究瘤内异质性及其克隆组成已成为了解肿瘤进展和行为的一个有吸引力的策略（3-7）。近年来，新兴的单细胞分析平台已经允许对肿瘤微环境（TME）进行深入分析，并且似乎是分离和分析肿瘤异质性的有前途的方法（8）。

Over the last decades, several efforts have been made to reduce mortality among lung cancer patients. While advances in diagnostic and therapeutics have occurred, long-term survival rates compared to other cancers have barely improved (1). Therefore, new approaches are needed. In the context of lung adenocarcinoma (ADC), this is of great importance due to the high rate of overdiagnosis and lack of accuracy in predicting indolent vs. aggressive behavior of the tumor (2). In order to better predict disease behavior, it is crucial to understand the cellular and molecular underpinnings of the tumor. Thus, the study of intratumor heterogeneity and its clonal composition has become an attractive strategy to understand tumor progression and behavior (3–7). In the recent years emerging single-cell analysis platforms have allowed the deep profiling of the tumor microenvironment (TME), and seem promising approaches for the dissection and of tumor heterogeneity (8).

Senosain MF, et al. Front Oncol. 2020. PMID: 32257951