Carr I
Cancer Metastasis Rev. 1983;2(3):307-17. doi: 10.1007/BF00048483.
Lymphatic metastasis is an important mechanism in the spread of human cancer. During its course, tumor cells first penetrate the basement of membrane of the epithelium, in which they arise, and then the underlying connective tissue, carried partly by hydrostatic pressure. They enter the lymphatic partly by active movement, pass up the lymphatic trunk; they then settle and proliferate in the subcapsular sinus, penetrate its endothelium and proliferate and destroy the node. There are varied forms of immune response in the node and in human nodes often a complex fibrous and vascular response. The degree of lymphocytic response may be important for prognosis. The nodal reaction may be stimulated by release of antigens from the tumor. One of the most studied animal models of lymphatic metastasis is that which occurs in the politeal node after injection of tumor into the footpad. This model has been used to show that tumor cells enter lymphatics through gaps in endothelium, probably between endothelial cells, and that lymph nodes can destroy small numbers of tumor cells. Local immunotherapy and chemotherapy can sterilize a lymph node of tumor cells; the modes of treatment used have included intralymphatic injection and encapsulation of chemotherapeutic agents in liposomes. Prior radiotherapy may accelerate metastasis possibly by making tumor cells shed into lymphatic vessels. Lymph nodes are rather poor barriers to tumor cells. The prognostic significance of lymph node metastasis varies within tumor type; if hematogenous metastasis is early, then the presence of lymph node metastasis is of lesser prognostic significance. Lymph nodes can probably destroy only small numbers of tumor cells. Tumor cell heterogeneity is of importance in many aspects of metastasis; while clonal variation may be of importance in determining lymph node metastasis, it is not yet clear how important this is, nor whether specific clones metastasize specifically to lymph nodes. Lymphography is well established in diagnosis of lymphatic metastasis. A recent interesting development has been to inject antibodies labeled with a radioactive label, and image the label in lymph nodes with a gamma-camera. If anti-tumor antibodies are used in this way it may be possible to detect lymph node metastasis. Within the expanding field of tumor metastasis, lymphatic metastasis needs much more attention, particularly in relation to the diagnosis and treatment of the lymphatic spread of human cancer.
淋巴转移是人类癌症扩散的重要机制。在这个过程中，肿瘤细胞首先穿透其起源处上皮的基底膜，然后在部分流体静压的作用下穿透下方的结缔组织。它们部分通过主动运动进入淋巴管，沿淋巴干上行；然后在被膜下窦定居并增殖，穿透其内皮并在淋巴结内增殖和破坏。淋巴结内存在多种免疫反应形式，在人体淋巴结中常出现复杂的纤维和血管反应。淋巴细胞反应的程度可能对预后很重要。淋巴结反应可能由肿瘤释放的抗原所刺激。研究最多的淋巴转移动物模型之一是将肿瘤注射到足垫后在腘窝淋巴结发生的转移。这个模型已被用于表明肿瘤细胞通过内皮细胞间的间隙（可能在内皮细胞之间）进入淋巴管，并且淋巴结能够破坏少量肿瘤细胞。局部免疫疗法和化疗可以使淋巴结内的肿瘤细胞失活；使用的治疗方式包括淋巴内注射以及将化疗药物包裹在脂质体中。先前的放射治疗可能会加速转移，可能是通过使肿瘤细胞脱落进入淋巴管。淋巴结对肿瘤细胞的屏障作用相当薄弱。淋巴结转移的预后意义在不同肿瘤类型中有所不同；如果血行转移较早发生，那么淋巴结转移的存在对预后的意义就较小。淋巴结可能只能破坏少量肿瘤细胞。肿瘤细胞异质性在转移的许多方面都很重要；虽然克隆变异在确定淋巴结转移方面可能很重要，但目前尚不清楚其重要程度如何，也不清楚特定克隆是否专门转移至淋巴结。淋巴造影在淋巴转移的诊断中已得到广泛应用。最近一个有趣的进展是注射用放射性标记物标记的抗体，并用γ相机对淋巴结中的标记物进行成像。如果以这种方式使用抗肿瘤抗体，就有可能检测到淋巴结转移。在肿瘤转移不断扩展的领域中，淋巴转移需要更多关注，特别是在人类癌症淋巴扩散的诊断和治疗方面。
