Bazhenova Lyudmila, Newton Paul, Mason Jeremy, Bethel Kelly, Nieva Jorge, Kuhn Peter
*Division of Hematology Oncology, Department of Medicine, Moore's Cancer Center, University of California San Diego, San Diego, California; †Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California; ‡Department of Mathematics, University of Southern California, Los Angeles, California; §Department of Pathology, Scripps Clinic, La Jolla, California; ‖Division of Oncology and Hematology, Billings Clinic, Billings, Montana; and ¶Department of Cell Biology, The Scripps Research Institute, La Jolla, California.
J Thorac Oncol. 2014 Apr;9(4):442-6. doi: 10.1097/JTO.0000000000000133.
Adrenal gland metastases are common in lung cancer. It is well recognized that aggressive treatment of solitary adrenal metastases leads to improved outcomes but the exact nature of adrenal deposits is not well understood. Controversy exists as to the routing of cancer cells to the adrenal gland with some believing that this transmission is lymphatic, in contrast to the more generally accepted theory of hematogenous spread. Recently published mathematical modeling of cancer progression strongly supports the lymphatic theory. With that in mind, we performed a literature review to look for biological plausibility of simulation results and believe that evidence supports the contention that metastases to the adrenal gland can be routed by means of lymphatic channels. This could explain improved survival for patients in whom solitary adrenal metastases are managed aggressively with surgical or radiation modalities. We are calling for clinical trials prospectively testing this hypothesis.
肾上腺转移在肺癌中很常见。众所周知，积极治疗孤立性肾上腺转移可改善预后，但肾上腺转移灶的确切性质尚不清楚。关于癌细胞转移至肾上腺的途径存在争议，一些人认为这种转移是通过淋巴途径，这与更普遍接受的血行播散理论相反。最近发表的癌症进展数学模型有力地支持了淋巴转移理论。考虑到这一点，我们进行了文献综述，以寻找模拟结果的生物学合理性，并认为有证据支持肾上腺转移可通过淋巴途径发生的观点。这可以解释为何对孤立性肾上腺转移患者采用手术或放疗等积极治疗可提高生存率。我们呼吁开展前瞻性临床试验来验证这一假说。
