[微环境与结直肠癌肝转移血管生成:手术意义]

[Microenvironment and colorectal liver metastases angiogenesis: surgical implications].

作者信息

Lim Chetana, Eveno Clarisse, Pocard Marc

机构信息

Hôpital Lariboisière, unité INSERM U965 (Université Paris-VII), équipe angiogenèse et recherche translationnelle, 2 rue Ambroise-Paré, Paris, France.

出版信息

Bull Cancer. 2013 Apr 1;100(4):343-50. doi: 10.1684/bdc.2013.1725.

Abstract

Stephen Paget's proposed an original "seed and soil" theory, with organ-preference patterns of tumor metastasis resulting in interaction between metastatic tumor cells and their specific microenvironment. There is many experimental and clinical data showing that this theory is validated. More recently, it has been suggested that early changes in the microenvironment at the distant sites, could be induced by the primary tumor, reported as "pre-metastatic niche" formation. Tumor cells could produce growth factors, cytokines which could facilitate the recruitment and the mobilization of the bone marrow-derived endothelial progenitor cells, and thus necessary for the tumor neovascularization and metastasis growth. Although the clinical value of the concept of the premetastatic niche is not yet elucidated, these data could encourage surgeons to perform the colorectal surgery first and then the liver surgery, in patients with synchronous colorectal liver metastases. The reciprocal interactions between primary tumor and microenvironment at the distant sites are therefore determinant for tumor progression. Taken together, the microenvironment is an important therapeutic target and surgeons and oncologist could discuss the choice of different surgical strategy for patient with synchronous colorectal liver metastases regarding the interaction with the microenvironment affected by primary tumor resection.

摘要

斯蒂芬·佩吉特提出了一个原创的“种子与土壤”理论,肿瘤转移的器官偏好模式导致转移性肿瘤细胞与其特定微环境之间产生相互作用。有许多实验和临床数据表明这一理论是成立的。最近,有人提出远处部位微环境的早期变化可能由原发性肿瘤诱导,这被报道为“前转移生态位”的形成。肿瘤细胞可以产生生长因子、细胞因子,这些因子可以促进骨髓来源的内皮祖细胞的募集和动员,因此对肿瘤新血管形成和转移生长是必要的。尽管前转移生态位概念的临床价值尚未阐明,但这些数据可能会鼓励外科医生在患有同时性结直肠癌肝转移的患者中先进行结直肠手术,然后进行肝脏手术。因此,原发性肿瘤与远处部位微环境之间的相互作用对肿瘤进展起决定性作用。综上所述,微环境是一个重要的治疗靶点,外科医生和肿瘤学家可以讨论针对同时性结直肠癌肝转移患者,鉴于原发性肿瘤切除对微环境的影响,选择不同手术策略的问题。

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