Predicting the Course of Metastatic Breast Cancer
Suppose a mathematiciancould tell you the chances that your cancer would spread and how long you are likely to live if it does metastasize? Would you want to know? Metastasis, becoming Stage 4, is what every cancer patient fears when she first hears her diagnosis. A new[数学模型]could give you more specific information about your prognosis.
Fiction vs. fact
“The cancer has spread. There’s nothing we can do.” That’s the script of every tearjerker cancer novel and movie. In the movie version, a montage shows a few sun-lit weeks of our heroine doing what she loves best accompanied by glorious background music. Then she lies in her hospital bed looking lovely, if a bit pale, as her family says goodbye. The end.
事实完全不同。对于大多数转移性患者，医生可以做点什么。第4阶段患者多年来可以生存富有成效的生活。是的，绝大多数将永远在医生的任命中挑战他们持有常规工作的能力;然而，许多人设法找到对他们最重要的时间和能量。但是，电影也没有显示的侧面。与虚构的版本不同，通过增加疼痛和残疾的痛苦，而不是快速过渡，死亡的道路往往标志着。
现场事项
Another fact missing from the information we get from both the media and our doctors is that the site of the metastasis determines both the length of survival and the quality of life for the patient.
南加州大学的研究人员使用了计算机编程和统计建模，以查看乳腺癌可以传播的所有不同方式以及哪些影响现场对生存的影响。他们在诊断训练时看着Sloan Kettering Memorial医院的446名患者的记录，但最终达到了第4阶段。他们跟踪了十年内癌症的进展，或直到患者死亡。他们为所有患者整理了这些信息，无论亚型，然后根据患者的激素受体和HER2状态再次查看它。
They used a model called aspatiotemporal progression diagram看起来像不同颜色的一系列同心circles showing the pathways that the cancers spread. The model predicts survival based on the pattern of disease progression.
他们的许多结果将令担心成为第4阶段的患者或者刚发现他们对单一站点进行转移的患者。他们发现，如果他们的转移到一个地方，大约三分之二的患者住了十年。和现场问题。百分之九十的癌症从乳腺蔓延到骨头仍然活着五年后仍然活着，而第一个转移遗址是大脑的20％。幸运的是，骨骼是转移最常见的遗址，而乳腺癌是不寻常的，首先到大脑。大约三分之二的女性在学习的十年结束时仍然活着。令人惊讶的是，涉及时间转移的越多的器官被诊断出来，预后更糟。
当我被诊断出来时，我个人会发现这种信息对我有帮助。我知道患有炎症乳腺癌的大多数人将在两年内成为第4阶段。虽然我害怕死亡，但我担心更多的是我的大脑的转移会影响我的思想。如果我看到了HER2阳性患者的图表，我本可以花费更少的能量担心。只有我类型的癌症的一小部分患者对大脑的第一个甚至第二次转移。
没有更多的刻板印象
It’s vital to keep in mind that this model is based on 446 women at a specific hospital between 1975 and 2009. Treatment for metastatic breast cancer has advanced since their diagnosis. It will be important to know if similar results occur with a larger sample from a wider distribution of institutions. But this information is important in changing our thinking away from a one-scenario-fits-all model.
Our perceptions of Stage IV patients are molded by our experience with a friend or family member. If we know someone who has held down a job for the last six years missing work only for doctors’ appointments, we tend to think of metastatic breast cancer as a treatable condition. If we watched our mother decline quickly, unable to find enough breath to hold a grandchild, we hear a diagnosis of Stage IV very differently.
这个数学模型向我们展示了我们的看法是刻板印象。在其中一个模型中的350名患者中，乳腺癌蔓延有207个不同的途径。这些途径中的每一个都带有不同的症状和不同的预期寿命。
Although we hear sad stories every day about breast cancer deaths, when we are in the doctor’s office for ourselves or a loved one, we need to ask more questions about our specific situation. We need to understand how our disease is similar or different from that of another Stage 4 sister. Then with appropriate facts, we can make plans.
Resources:
牛顿，P.等。转移性乳腺癌的时尚进展：Markov链模型突出了早期转移性位点的作用。npj Breast Cancer.October 21, 2015. Accessed fromhttp://www.nature.com/articles/npjbcancer201518#f1January 26, 2016.
