Wittekind C
Abteilung für Pathologie, Friedrich-Alexander-Universität Erlangen.
Zentralbl Chir. 1996;121(6):435-41.
The process of lymphatic and hematogenous metastasis has been elucidated in recent years by thorough morphological studies on resection specimens and new findings in the field of molecular biology. However, this process is far from being completely understood. Metastasis is a multistep process requiring numerous interactions of tumor cells with the surrounding matrix. Especially, adhesion, invasion of basement membranes and passage through extracellular matrix are active processes taking place in the tissue of the primary tumor and later on in host tissues. Metastases to distant organs can be the result of a venous invasion of the primary tumour as well as lymphovenous short-circuits or by the thoracic duct. Using immunohistological methods, tumor cells can be detected in lymph nodes, blood and bone marrow. This not termed metastasis, these cells are classified as isolated tumor cells (M1(i)). The frequency of lymph node metastasis depends on the intensity of histological examination. In colorectal carcinomas the risk of metastatic lymph nodes can be estimated by conventional parameters such as pT category of the primary tumor, histological grade or invasion of lymphatic vessels. The benefit of applying molecular markers (such as nm23-H1) is unclear. The successful removal of hepatic metastasis of colorectal carcinomas requires a more precise classification. A proposal of a more detailed and clarified classification will be discussed.
近年来，通过对切除标本的全面形态学研究以及分子生物学领域的新发现，淋巴道转移和血行转移的过程已得到阐明。然而，这一过程远未被完全理解。转移是一个多步骤过程，需要肿瘤细胞与周围基质进行大量相互作用。特别是，黏附、基底膜侵袭以及穿过细胞外基质是在原发肿瘤组织以及随后在宿主组织中发生的活跃过程。远处器官转移可能是原发肿瘤静脉侵犯、淋巴静脉短路或通过胸导管的结果。使用免疫组织学方法，可以在淋巴结、血液和骨髓中检测到肿瘤细胞。这并非所谓的转移，这些细胞被归类为孤立肿瘤细胞（M1(i)）。淋巴结转移的频率取决于组织学检查的强度。在结直肠癌中，转移淋巴结的风险可以通过常规参数来估计，如原发肿瘤的pT类别、组织学分级或淋巴管侵犯情况。应用分子标志物（如nm23-H1）的益处尚不清楚。成功切除结直肠癌肝转移需要更精确的分类。将讨论一项更详细和明确的分类建议。
