Sellner Franz, Thalhammer Sabine, Klimpfinger Martin
Department of General, Visceral and Vascular Surgery, Clinic Favoriten, Kaiser Franz Josef Hospital, 1100 Vienna, Austria.
Clinical Institute of Pathology, Medical University, 1090 Vienna, Austria.
Cancers (Basel). 2023 Jan 4;15(2):339. doi: 10.3390/cancers15020339.
A meta-analysis of 1470 isolated pancreatic metastases of renal cell carcinoma revealed, that, in addition to the unusual exclusive occurrence of pancreatic metastases and the favourable treatment results, the isPMRCC is characterised by further peculiarities of the clinical course: The lack of prognostic significance of volume and growth rate dependent risk factors and the independence of treatment results from standard or local resections. As an explanation for all these peculiarities, according to today's knowledge, a strong acting seed and soil mechanism can serve, which allows embolized tumour cells to grow to metastases only in the pancreas, and prevents them definitively or for years in all other organs. The good prognosis affects not only isolated PM, but also multi-organ metastases of the RCC, in which the additional occurrence of PM is also associated with a better prognosis. Genetic studies revealed specific changes in cases of PM of RCC: Lack of loss of 9p21.3 and 14q31.2, which are otherwise specific gene mutations at the onset of generalization, a low weight genome instability index, i.e., high genetic stability, and a low rate of PAB1 and a high rate of BPRM1 alterations, which signal a more favourable course. The cause of pancreatic organotropism in isPMRCC is still unclear, so only those factors that have been identified as promoting organotropism in other, more frequent tumour entities can be presented: Formation of the pre-metastatic niche, chemokine receptor-ligand mechanism, ability to metabolic adaptation, and immune surveillance.
一项对1470例肾细胞癌孤立性胰腺转移瘤的荟萃分析显示，除了胰腺转移瘤的罕见单纯发生以及良好的治疗效果外，孤立性胰腺转移肾细胞癌（isPMRCC）还具有临床病程的其他特点：体积和生长速率依赖性风险因素缺乏预后意义，治疗结果不依赖于标准或局部切除术。根据目前的知识，一种强大的种子与土壤机制可以解释所有这些特点，该机制使栓塞的肿瘤细胞仅在胰腺中生长为转移瘤，并在所有其他器官中最终阻止或多年来阻止其生长。良好的预后不仅影响孤立性胰腺转移瘤，也影响肾细胞癌的多器官转移，其中胰腺转移瘤的额外发生也与较好的预后相关。基因研究揭示了肾细胞癌胰腺转移病例的特定变化：缺乏9p21.3和14q31.2的缺失，而在其他情况下，这些缺失是转移开始时的特定基因突变；基因组不稳定指数较低，即遗传稳定性高；PAB1发生率低，BPRM1改变发生率高，这表明病程更有利。isPMRCC中胰腺器官嗜性的原因仍不清楚，因此只能列出那些在其他更常见肿瘤实体中已被确定为促进器官嗜性的因素：前转移小生境的形成、趋化因子受体-配体机制、代谢适应能力和免疫监视。
