Weiss L, Voit A, Lane W W
Invasion Metastasis. 1984;4(1):47-60.
The frequency of metastatic involvement of eight target organs was examined in people dying as a consequence of squamous cell carcinomas of the lower third of the esophagus or adenocarcinomas of the upper third of the rectum. In both groups, there was a stronger association of metastatic incidence in the target organs with organ blood flow per gram in patients with liver metastases than without. The results suggest that this association, which is consistent with the 'mechanical' hypothesis of metastatic pattern, is only seen in people with advanced disease and that in the others temporal limitations imposed by death or cure prevent full development of the pattern. The data suggest that in accord with the 'cascade' theory, cancer cells must first form metastases in the liver, that cells from these metastases not the primary cancer, then form metastases in the lungs; cancer cells from the lung metastases then subsequently disseminate with a trend towards an arterial pattern. Data from animal experiments suggest that owing to the inefficiency of the metastatic process in terms of cancer cells, this sequential process is slow relative to tumor development and that this time base affects expression of metastatic pattern. This proposed scheme for metastatic pattern development provides evidence in favor of Ewing's 'mechanical' hypothesis for two histologic types of cancer, each growing in one designated primary site. It does not exclude a role for 'seed and soil' effects in these and other cancers.
对因食管下三分之一鳞状细胞癌或直肠上三分之一腺癌死亡的人群，研究了八个靶器官的转移累及频率。在这两组中，与无肝转移的患者相比，有肝转移的患者靶器官转移发生率与每克器官血流量之间的关联更强。结果表明，这种与转移模式的“机械”假说相符的关联，仅在晚期疾病患者中可见，而在其他患者中，死亡或治愈所带来的时间限制阻止了这种模式的充分发展。数据表明，根据“级联”理论，癌细胞必须首先在肝脏形成转移灶，然后这些转移灶而非原发癌的细胞在肺部形成转移灶；肺转移灶的癌细胞随后以动脉模式扩散。动物实验数据表明，由于癌细胞转移过程效率低下，相对于肿瘤发展而言，这个连续过程较为缓慢，且这个时间基础会影响转移模式的表达。这种提出的转移模式发展方案为尤因的“机械”假说提供了证据，该假说适用于两种组织学类型的癌症，每种癌症都在一个指定的原发部位生长。它并不排除“种子与土壤”效应在这些及其他癌症中的作用。
