文章：

压力与癌症：机制、意义和未来方向

Stress and cancer: mechanisms, significance and future directions

原文发布日期：2021-09-10

DOI: 10.1038/s41568-021-00395-5

类型: Review Article

开放获取: 否

英文摘要：

The notion that stress and cancer are interlinked has dominated lay discourse for decades. More recent animal studies indicate that stress can substantially facilitate cancer progression through modulating most hallmarks of cancer, and molecular and systemic mechanisms mediating these effects have been elucidated. However, available clinical evidence for such deleterious effects is inconsistent, as epidemiological and stress-reducing clinical interventions have yielded mixed effects on cancer mortality. In this Review, we describe and discuss specific mediating mechanisms identified by preclinical research, and parallel clinical findings. We explain the discrepancy between preclinical and clinical outcomes, through pointing to experimental strengths leveraged by animal studies and through discussing methodological and conceptual obstacles that prevent clinical studies from reflecting the impacts of stress. We suggest approaches to circumvent such obstacles, based on targeting critical phases of cancer progression that are more likely to be stress-sensitive; pharmacologically limiting adrenergic–inflammatory responses triggered by medical procedures; and focusing on more vulnerable populations, employing personalized pharmacological and psychosocial approaches. Recent clinical trials support our hypothesis that psychological and/or pharmacological inhibition of excess adrenergic and/or inflammatory stress signalling, especially alongside cancer treatments, could save lives.

摘要翻译： 

数十年来，压力与癌症相互关联的观点一直主导着公众讨论。近期动物研究表明，压力可通过调控大多数癌症特征显著促进癌症进展，介导这些效应的分子与系统机制也已得到阐明。然而，此类有害效应的现有临床证据并不一致，因为流行病学和减压临床干预对癌症死亡率的影响效果参差不齐。本综述将描述并讨论临床前研究发现的特定介导机制，以及与之对应的临床研究结果。我们通过指出动物研究利用的实验优势，并探讨阻碍临床研究反映压力影响的方法学与概念性障碍，来解释临床前研究与临床结果之间的差异。我们提出以下规避障碍的方法：针对更易受压力影响的癌症进展关键阶段；通过药物手段限制医疗操作引发的肾上腺素能-炎症反应；聚焦更脆弱人群，采用个性化药物及心理社会干预方案。近期临床试验支持我们的假说：尤其是在癌症治疗期间，通过心理和/或药物手段抑制过度的肾上腺素能及炎症应激信号传导，可能挽救患者生命。

原文链接：

Stress and cancer: mechanisms, significance and future directions