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主题:【讨论】肿瘤治疗:进展中的瓶颈还是瓶颈中的进展? -- chalet

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家园 正好刚看到CA报告的消息

随便说2句。

昨天刚发完帖子,邮箱就收到Medscape的e-newsletter,其中一条就是关于ca报告的报道和采访。

链接在这里:http://www.medscape.com/viewarticle/725018?src=mpnews&spon=7&uac=74285DV 。看不到的话先注册一下。

里面内有段话我觉得基本解释了发病率、死亡率下降的原因。

Reflecting on the reasons for the declines in cancer rates that are now being seen, Dr. Lichtenfeld suggests that "not all of this was due to some remarkable breakthrough in medical treatment, although some of it certainly is due to better cancer care. Much of it has to do with stopping smoking, or not starting for that matter, especially among men. Much of it has to do with better screening and early detection of breast and colorectal cancer, and perhaps prostate cancer (although we are not certain about the latter). Some of it may have to do with lifestyle changes, such as increased awareness of the importance of exercise and diet in reducing cancer risk."

也就是说从宏观角度来说,单纯的肿瘤治疗贡献还是比较弱的。同期e-newsletter还有一条关于英国的同类报道: Survival Times for Major Cancers Have Doubled in UK,这是用07年数据和1971/72进行比较的结果。不知道这个分析的结论和Dr. Lichtenfeld的观点是否一致,如果一致的话,那可能意味着从一个长的时间跨度来看,肿瘤治疗真的成了瓶颈中的前进,而不是前进遇到暂时的瓶颈了。

如果说到当前肿瘤临床的方向,我同意您的观点,循证医学和多学科治疗是主要的2大工具,把现有手段发挥到作用最大,当是临床医生的责任。而对个体化治疗的热度,可以稍微降一降,等待更多有意义的标志物出现。

至于未来的肿瘤治疗,我脑海中总有一个奇怪的景象:以后的医院可能象是个前店后厂的模式,前面收病人、取样本,后面分析、分型(companion diagnostics将来会成为肿瘤治疗的核心环节之一),并依此挑选合适的药物或定制针对性的疫苗/工程细胞/人工组织,再送到前面去使用。痴人说梦,供一笑。

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