Nathanson S D, Shah R, Rosso K
Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
Semin Cell Dev Biol. 2015 Feb;38:106-16. doi: 10.1016/j.semcdb.2014.10.002. Epub 2014 Nov 4.
Malignant tumors of ectodermal or endodermal origin may metastasize to the sentinel lymph node, the first lymph node encountered by tumor cells that enter lymphatics in the organ of origin. This pathway is enabled by the anatomy of the disease and the causes of metastasis are the result of complex interactions that include mechanical forces within the tumor and host tissues, and molecular factors initiated by tumor cell proliferation, elaboration of cytokines and changes in the tumor microenvironment. Mechanical stresses may influence complex biochemical, genetic and other molecular events and enhance the likelihood of metastasis. This paper summarizes our understanding of interacting molecular, anatomical and mechanical processes which facilitate metastasis to SLNs. Our understanding of these interacting events is based on a combination of clinical and basic science research, in vitro and in vivo, including studies in lymphatic embryology, anatomy, micro-anatomy, pathology, physiology, molecular biology and mechanobiology. The presence of metastatic tumor in the SLN is now more accurately identifiable and, based upon prospective clinical trials, paradigm-changing SLN biopsy has become the standard of clinical practice in breast cancer and melanoma.
起源于外胚层或内胚层的恶性肿瘤可能会转移至前哨淋巴结，即肿瘤细胞在原发器官进入淋巴管后所遇到的首个淋巴结。这种转移途径由疾病的解剖结构所决定，转移的原因是复杂相互作用的结果，这些相互作用包括肿瘤和宿主组织内的机械力，以及由肿瘤细胞增殖、细胞因子分泌和肿瘤微环境变化引发的分子因素。机械应力可能会影响复杂的生化、遗传及其他分子事件，并增加转移的可能性。本文总结了我们对促进肿瘤转移至前哨淋巴结的分子、解剖和机械相互作用过程的理解。我们对这些相互作用事件的理解基于临床和基础科学研究的结合，包括体外和体内研究，涵盖淋巴系统胚胎学、解剖学、微观解剖学、病理学、生理学、分子生物学和力学生物学等方面。前哨淋巴结中转移性肿瘤的存在现在能够更准确地识别，并且基于前瞻性临床试验，改变范式的前哨淋巴结活检已成为乳腺癌和黑色素瘤临床实践的标准。
