Natural selection in neoplastic progression of Barrett's esophagus.
Neoplasms progress to cancer through a process of natural selection. The rate of evolution, and thus progression is determined by three parameters: mutation rate, population size of the evolving neoplastic cells, and intensity of selection or rate of clonal expansion. All three parameters are reviewed in the context of Barrett's esophagus, a pre-malignant neoplasm. Although Barrett's esophagus is an ideal model for the study of neoplastic clonal evolution, similar studies may be carried out in a wide variety of human neoplasms. Evolutionary analyses provide insights for clinical management, including rates of progression to cancer and emergence of resistance to interventions.
Maley
Carlo C
CC
Molecular and Cellular Oncogenesis Program, The Wistar Institute, 3601 Spruce St., Philadelphia, PA 19104, USA. cmaley@alum.mit.edu
Reid
Brian J
BJ
D001471:Barrett Esophagus / Q000235:genetics*; D002471:Cell Transformation, Neoplastic / Q000235:genetics*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000235:genetics*; D019143:Evolution, Molecular; D006801:Humans; D009154:Mutation; D012641:Selection, Genetic