菠萝：癌症到底怎么归类的？ 从1.0版到4.0版。
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-0bcd26044702f68d543a04e22bb49de9_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“菠萝，肺癌有新药<span style="color: black;">能够</span>用么？”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">详细</span>是什么癌症类型呢？”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“说了是肺癌啊。”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“这恐怕还<span style="color: black;">不足</span>，<span style="color: black;">必要</span><span style="color: black;">认识</span>一下<span style="color: black;">详细</span>是肺癌的哪一种。”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">通常</span>问起癌症种类，<span style="color: black;">大众</span><span style="color: black;">第1</span>反应都是肺癌，乳腺癌，直肠癌，等等。这没错，但这是癌症<span style="color: black;">归类</span>最初级的1.0版。在过去一百<span style="color: black;">数年</span>，随着现代医学的发展，癌症<span style="color: black;">归类</span>方式<span style="color: black;">已然</span><span style="color: black;">显现</span>了4次革命性升级，从最初的1.0版，到2.0，到3.0，<span style="color: black;">此刻</span>最新的4.0版<span style="color: black;">已然</span>出<span style="color: black;">此刻</span>地平线上。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">归类</span>方式的<span style="color: black;">持续</span>升级，其<span style="color: black;">基本</span>目的，都是为了对病人进行更好的“个性化治疗”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">仅有</span><span style="color: black;">认识</span>现代癌症<span style="color: black;">归类</span>方式，<span style="color: black;">才可</span>更好地和<span style="color: black;">大夫</span>交流，<span style="color: black;">认识</span>新药<span style="color: black;">暗地里</span>原理，从而<span style="color: black;">选取</span>最适合<span style="color: black;">病人</span>的治疗方式。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">归类</span>1.0</strong><strong style="color: blue;">版</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一千<span style="color: black;">数年</span>前，<span style="color: black;">显现</span>了癌症的概念。慢慢的，大家<span style="color: black;">起始</span>对癌症<span style="color: black;">根据</span>发病部位，<span style="color: black;">或</span>说癌症组织<span style="color: black;">源自</span>来<span style="color: black;">归类</span>，<span style="color: black;">例如</span>肺癌，胃癌，直肠癌等等。<span style="color: black;">这般</span>的<span style="color: black;">归类</span>直观，容易理解，<span style="color: black;">咱们</span>平时说肿瘤排名，<span style="color: black;">亦</span>还是<span style="color: black;">根据</span><span style="color: black;">这般</span>的<span style="color: black;">归类</span>来的。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-70b2f47e216668e187ee3d5c17b1bffb_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这种<strong style="color: blue;"><span style="color: black;">根据</span>“部位”的<span style="color: black;">归类</span>，是“癌症<span style="color: black;">归类</span>1.0版”</strong>
</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">。这虽然简单，却<span style="color: black;">亦</span>是一次革命，<span style="color: black;">由于</span><span style="color: black;">这般</span><span style="color: black;">归类</span>不仅让互相的交流变得容易，<span style="color: black;">况且</span>有临床价值，<span style="color: black;">由于</span>显然肺癌和乳腺癌，从生长特性到治疗手段，都是非常不同的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">归类</span>2.0</strong><strong style="color: blue;">版</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随着技术进步，<span style="color: black;">大夫</span><span style="color: black;">发掘</span><span style="color: black;">能够</span><span style="color: black;">按照</span>临床特征，尤其是显微镜下癌细胞的特点（病理）对癌症再进行细分。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">归类</span>2.0版：“部位+临床病理”</strong>。病理科<span style="color: black;">大夫</span>的<span style="color: black;">重点</span>工作，<span style="color: black;">便是</span><span style="color: black;">根据</span>2.0版的标准，来对病人进行<span style="color: black;">归类</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">例如</span>，下图<span style="color: black;">便是</span>2.0版本里面，4种<span style="color: black;">重点</span>肺癌类型在显微镜下的不<span style="color: black;">一样</span>子。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-e286965364ec62645801974e50f241a0_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">从1.0升级到2.0版，中间经历了上千年，<span style="color: black;">表现</span>了<span style="color: black;">没</span>数<span style="color: black;">大夫</span>和<span style="color: black;">专家</span>的智慧。<span style="color: black;">咱们</span><span style="color: black;">起始</span>真正认识到癌症多样性，证明<span style="color: black;">一样</span>部位，不同亚型的病人<span style="color: black;">运用</span>不同治疗方式，能达到更优化的效果。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然则</span><span style="color: black;">大众</span>慢慢<span style="color: black;">发掘</span>2.0版有问题。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第1</span>，这种<span style="color: black;">归类</span><span style="color: black;">重点</span>靠病理科<span style="color: black;">大夫</span>经验和主观判断，水平不高的话很容易<span style="color: black;">显现</span>误判。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">第二，即使分为同一种亚型的病人，<span style="color: black;">例如</span>“晚期非小细胞腺癌”，对<span style="color: black;">药品</span>的响应非常不同，<span style="color: black;">大夫</span>仍然<span style="color: black;">没</span>法准确预测病人对<span style="color: black;">药品</span>的响应。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">咱们</span><span style="color: black;">可否</span>能找到更好的<span style="color: black;">归类</span><span style="color: black;">办法</span>，来<span style="color: black;">帮忙</span><span style="color: black;">大夫</span>优化治疗<span style="color: black;">方法</span>？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基因测序带来了一线曙光。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">归类</span>3.0</strong><strong style="color: blue;">版</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">进入21世纪，随着癌症中的基因突变被<span style="color: black;">逐步</span><span style="color: black;">发掘</span>并理解，<span style="color: black;">咱们</span>进入了<strong style="color: blue;">癌症<span style="color: black;">归类</span>3.0版时代：“部位+病理+基因突变”。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在3.0系统下，基因检测<span style="color: black;">成为了</span>不可或缺的一环，<span style="color: black;">因此呢</span>有时<span style="color: black;">亦</span>叫“基因分型”<span style="color: black;">或</span>“分子分型”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">例如</span>“非小细胞肺腺癌”，在2.0<span style="color: black;">归类</span>中是“同病”，而在3.0<span style="color: black;">归类</span>下则<span style="color: black;">能够</span>被进一步细分<span style="color: black;">成为了</span>“EGFR基因突变”，“ALK基因融合”，“KRAS基因突变”等近十种不同的<span style="color: black;">疾患</span>。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-7470b1230f2e389283e77721f92e7862_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">之<span style="color: black;">因此</span>要这么<span style="color: black;">归类</span>，是<span style="color: black;">由于</span>科学<span style="color: black;">科研</span><span style="color: black;">显示</span>，不同基因突变的肺癌，对<span style="color: black;">药品</span>，尤其是新型靶向<span style="color: black;">药品</span>的响应是非常不同的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">如下图，当靶向<span style="color: black;">药品</span>“特罗凯”用于所有“非小细胞腺癌”的时候，疗效差别很大，有些人结果非常好，<span style="color: black;">非常多</span>人则<span style="color: black;">无</span>任何效果，肿瘤<span style="color: black;">乃至</span>还在快速生长。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为何</span>呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以前，在2.0版<span style="color: black;">归类</span>下，<span style="color: black;">咱们</span>完全<span style="color: black;">没</span>法理解。直到<span style="color: black;">运用</span>基因检测才<span style="color: black;">发掘</span>，特罗凯在肺癌中的疗效<span style="color: black;">重点</span>由病人基因突变类型决定：EGFR突变病人<span style="color: black;">常常</span>效果不错<strong style="color: blue;">（灰色）</strong>，而相反，<span style="color: black;">倘若</span>癌细胞是KRAS突变的时候<strong style="color: blue;">（蓝色）</strong>，“特罗凯”是完全<span style="color: black;">没</span>效的。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-74603f6be1a5659bb406f080c7a7519d_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">正是<span style="color: black;">由于</span>类似的临床<span style="color: black;">实验</span>结果，<span style="color: black;">大夫</span><span style="color: black;">起始</span><span style="color: black;">举荐</span>病人进行基因检测，<span style="color: black;">根据</span><span style="color: black;">可否</span>有EGFR， ALK，或KRAS突变来进一步<span style="color: black;">归类</span>，从而决定病人<span style="color: black;">可否</span>适合<span style="color: black;">运用</span>“特罗凯”，“易瑞沙”等不同靶向<span style="color: black;">药品</span>。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-6630889b0ec2678c7f9168958be86107_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随着<span style="color: black;">归类</span>方式的进步，<span style="color: black;">大众</span>和<span style="color: black;">大夫</span>的对话<span style="color: black;">亦</span>变了：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.0时代： “我爸爸的<strong style="color: blue;">肺癌</strong>应该怎么治？”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.0时代： “我爸爸的<strong style="color: blue;">3期非小细胞肺腺癌</strong>应该怎么治？”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.0时代：“我爸爸的<strong style="color: blue;">EGFR基因19号外显子突变，3期非小细胞肺腺癌</strong>应该怎么治？”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">显然是越来越<span style="color: black;">繁杂</span>。但<span style="color: black;">大众</span>先别崩溃，这还没完，<span style="color: black;">由于</span>伴随免疫疗法兴起，4.0版呼之欲出。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">归类</span>4.0版</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">近两年来，“部位+病理+基因”的癌症<span style="color: black;">归类</span>3.0版，又<span style="color: black;">不足</span>用了，<span style="color: black;">由于</span>它<span style="color: black;">没</span>法预测<span style="color: black;">近期</span>很火的免疫疗法效果。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">归类</span>4.0版：“位置+病理+基因突变+免疫特性”</strong>，是<span style="color: black;">日前</span>最热门的<span style="color: black;">科研</span><span style="color: black;">行业</span>之一。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">或许再过几年，<span style="color: black;">咱们</span>就得<span style="color: black;">这般</span>问<span style="color: black;">大夫</span>了：“我爸爸的<strong style="color: blue;">PD-L1阳性1+，CD8细胞阳性1+，新抗原指数2+， EGFR基因19号外显子突变，3期非小细胞肺腺癌</strong>应该怎么治？”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">99%的人应该<span style="color: black;">已然</span>晕菜了，这很正常。别担心，这是科学<span style="color: black;">科研</span>最前沿，还不成熟，暂时不会广泛用于临床。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但4.0版是不可阻挡的趋势，<span style="color: black;">因此</span>我<span style="color: black;">意见</span><span style="color: black;">大众</span><strong style="color: blue;">要不就早点<span style="color: black;">起始</span>学习，要不就多结交点学生物医学的<span style="color: black;">伴侣</span>。</strong></p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-9c4b340de020f174c306e7140f9e07f7_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">每一个</span>人的癌症都是不同的，为了最优化治疗，癌症类型肯定会被分得越来越细，终极结果<span style="color: black;">便是</span>每位<span style="color: black;">病人</span>都是一种独特分型，适合独特的治疗方式，<span style="color: black;">所说</span>“一人一方”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但当<span style="color: black;">归类</span>过于细，过于<span style="color: black;">繁杂</span>的时候，会带来一个大问题：不仅病人，连<span style="color: black;">非常多</span><span style="color: black;">大夫</span>都会懵圈，<span style="color: black;">由于</span>信息和<span style="color: black;">选取</span>都实在太多了。咋办？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此时</span>候，<span style="color: black;">必须</span>一个傻瓜软件，只要输入各项信息，电脑就能输出<span style="color: black;">举荐</span>治疗<span style="color: black;">方法</span>，<span style="color: black;">例如</span>下面这种：</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-d329aad1fee6ea108a42f2b23373e2b6_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">理想状态下，<span style="color: black;">举荐</span>出来的应该不是一种固定<span style="color: black;">方法</span>，而是会有多个<span style="color: black;">选取</span>，按成功概率，价格，副<span style="color: black;">功效</span><span style="color: black;">危害</span>等<span style="color: black;">原因</span>排名，就跟<span style="color: black;">此刻</span>买机票，订旅馆<span style="color: black;">同样</span>。<span style="color: black;">选取</span>一个最适合病人需求的疗法。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">它最大的难点是<span style="color: black;">暗地里</span>的数据库，不仅<span style="color: black;">必须</span>随时更新临床<span style="color: black;">科研</span>结果，还<span style="color: black;">必须</span>人工智能学习能力，门槛不低。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">有人<span style="color: black;">已然</span><span style="color: black;">起始</span>做了，我相信这是一个在不久的<span style="color: black;">将来</span>就会爆发的商机。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考文献：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1. What Can We Learn from Genomically-Driven Trialsin Other Tumors? FDA Breast Oncology Group.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2. The BATTLE Trial: Personalizing Therapy forLung Cancer. Cancer Discovery. 2011Jun;1(1):44-53</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3. Clinical Trials of Precision Medicinethrough Molecular Profiling: Focus on Breast Cancer. Am Soc Clin Oncol Educ Book. 2015:e183-90.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4. <a style="color: black;"><span style="color: black;">http://www.</span><span style="color: black;">focus4trial.org/</span></a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">Austen Everett & Matt Luzunaris</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">恢复</span>者 </strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">（淋巴癌）</strong></p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-019fe5fe085ca6c11e484f2f3d247252_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
外贸B2B平台有哪些？ 谢谢、感谢、感恩、辛苦了、有你真好等。 楼主节操掉了，还不快捡起来！ 论坛的成果是显著的，但我们不能因为成绩而沾沾自喜。
页:
[1]