Kim Dae Joong
Department of Orthopaedics, West Virginia University, Morgantown, WV 26506, USA.
WVU Cancer Institute, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA.
Int J Mol Sci. 2026 Jan 15;27(2):875. doi: 10.3390/ijms27020875.
Metastasis is still the leading cause of cancer-related death. It happens when disseminated tumor cells (DTCs) successfully navigate a series of steps and adapt to the unique conditions of distant organs. In this review, key molecular and immune mechanisms that shape metastatic spread, long-term survival, and eventual outgrowth are examined, with a focus on how tumor-intrinsic programs interact with extracellular matrix (ECM) remodeling, angiogenesis, and immune regulation. Gene networks that sustain tumor-cell plasticity and invasion are described, including EMT-linked transcription factors such as SNAIL and TWIST, as well as broader transcriptional regulators like SP1. Also, how epigenetic mechanisms, such as EZH2 activity, DNA methylation, chromatin remodeling, and noncoding RNAs, lock in pro-metastatic states and support adaptation under therapeutic pressure. Finally, proteases and matrix-modifying enzymes that physically and biochemically reshape tissues, including MMPs, uPA, cathepsins, LOX/LOXL2, and heparinase, are discussed for their roles in releasing stored growth signals and building permissive niches that enable seeding and colonization. In parallel, immune-evasion strategies that protect circulating and newly seeded tumor cells are discussed, including platelet-mediated shielding, suppressive myeloid populations, checkpoint signaling, and stromal barriers that exclude effector lymphocytes. A major focus is metastatic dormancy, cellular, angiogenic, and immune-mediated, framed as a reversible survival state regulated by stress signaling, adhesion cues, metabolic rewiring, and niche constraints, and as a key determinant of late relapse. Tumor-specific metastatic programs across mesenchymal malignancies (osteosarcoma, chondrosarcoma, and liposarcoma) and selected high-burden cancers (melanoma, hepatocellular carcinoma, glioblastoma, and breast cancer) are highlighted, emphasizing shared principles and divergent organotropisms. Emerging therapeutic strategies that target both the "seed" and the "soil" are also discussed, including immunotherapy combinations, stromal/ECM normalization, chemokine-axis inhibition, epigenetic reprogramming, and liquid-biopsy-enabled minimal residual disease monitoring, to prevent reactivation and improve durable control of metastatic disease.
转移仍然是癌症相关死亡的主要原因。当播散性肿瘤细胞(DTCs)成功地经历一系列步骤并适应远处器官的独特条件时,转移就会发生。在这篇综述中,我们研究了影响转移扩散、长期存活以及最终生长的关键分子和免疫机制,重点关注肿瘤内在程序如何与细胞外基质(ECM)重塑、血管生成和免疫调节相互作用。描述了维持肿瘤细胞可塑性和侵袭的基因网络,包括与上皮-间质转化(EMT)相关的转录因子,如SNAIL和TWIST,以及更广泛的转录调节因子,如SP1。此外,还探讨了表观遗传机制,如EZH2活性、DNA甲基化、染色质重塑和非编码RNA,如何锁定促转移状态并在治疗压力下支持适应性。最后,讨论了蛋白酶和基质修饰酶在物理和生化层面重塑组织的作用,包括基质金属蛋白酶(MMPs)、尿激酶型纤溶酶原激活剂(uPA)、组织蛋白酶、赖氨氧化酶/赖氨氧化酶样蛋白2(LOX/LOXL2)和肝素酶,它们在释放储存的生长信号和构建允许肿瘤细胞播种和定植的有利微环境方面发挥作用。同时,还讨论了保护循环中及新播种的肿瘤细胞的免疫逃逸策略,包括血小板介导的屏蔽、抑制性髓系细胞群体、检查点信号传导以及排除效应淋巴细胞的基质屏障。一个主要关注点是转移休眠,包括细胞、血管生成和免疫介导的休眠,它被视为一种由应激信号、黏附线索、代谢重编程和微环境限制调节的可逆存活状态,也是晚期复发的关键决定因素。强调了间充质恶性肿瘤(骨肉瘤、软骨肉瘤和脂肪肉瘤)以及某些高负担癌症(黑色素瘤、肝细胞癌、胶质母细胞瘤和乳腺癌)中的肿瘤特异性转移程序,突出了共同原则和不同的器官趋向性。还讨论了针对“种子”和“土壤”的新兴治疗策略,包括免疫治疗联合、基质/ECM正常化、趋化因子轴抑制、表观遗传重编程以及基于液体活检的微小残留病监测,以防止复发并改善对转移性疾病的持久控制。