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The new findings in the July 7 issue of Science magazine break the common sense: For most patients with colorectal cancer, "long-distance" cancer metastasis originates from the primary tumor and is independent of any lymph node metastasis. This study provides the first direct genetic evidence for the mystery that complete lymph node dissection does not provide survival advantages in many malignancies.
Researchers at the Massachusetts General Hospital (MGH) have found that the traditional pattern of cancer cell spread—from the primary tumor to the spread of nearby lymph nodes to other organs—may not be applicable to all situations. In an article in the July 7 issue of Science, the researchers described the findings that for most patients with colorectal cancer, "long-distance" cancer metastasis originates from the primary tumor and is independent of any lymph node metastasis.
Dr. Kamila Naxerova, First and Corresponding author, said: "Our findings provide exceptional evidence for a model that has been around for a century, in which human lymph node metastasis is a precursor to long-distance transfer, indicating that it is not Applicable to all or most colorectal cancers. These findings fill an important gap in our understanding of the development of metastatic disease and may guide the clinical treatment of lymph node metastasis."
Repeated sequence mutations into tags reveal that most colorectal cancers do not spread through lymph
The current study is a follow-up to a research article published in PNAS in 2014. Naxerova and her colleagues describe a simple experiment based on the analysis of small, prone-mutated, poly-G repeats in the genome. Sequences can reveal evolutionary relationships between tumors in different parts of the patient's body. The study found that primary and metastatic tumors are different in various situations. For example, metastases occur early in some patients, while tumors develop later in other patients. The detection method can also identify which regions of the primary tumor have become a specific source of cancer metastasis based on their genetic maps.
The treatment of most solid tumors is now divided into TNM - primary tumor (T), lymph node metastasis (N) and long-distance metastasis (M) staging. Patients with lymph node metastasis are more likely to have distant metastases, which means a link between the two. However, in recent clinical trials, lymph node dissection for cancer metastasis does not always improve patient survival, and researchers question the relationship between lymph node metastasis and distant metastasis. To better understand the relationship between primary tumors and two types of metastases, the researchers used poly-G classification to analyze more than 200 primary tumors, lymph node metastases, and distantly metastatic tissues in 17 colorectal cancer patients. sample.
In 35% of patients, the results showed that both lymph nodes and distant metastasis originated from the same cell type of the primary tumor, and the results were consistent with the traditional pattern of primary lesions spreading to the lymph nodes and then transferring to distant sites. However, in 65% of patients, the poly-G classification showed a different cell type for lymph node metastasis and distant metastasis, matching different types of cells in the primary tumor, indicating that these types of metastasis are of independent origin.
The authors who participated in the study pointed out the significance of the study
Naxerova said, "We now suspect that lymph node metastasis only indicates the presence of a positive primary tumor, rather than the direct responsible for the formation of distant metastases. Now we need to study patients with common origins of lymph nodes and distant metastases, and those Whether the clinical outcomes of patients with different evolutionary origins are different. If there is a difference, our approach may be a useful prognostic test in the future."
Dr. Rakesh K. Jain, a senior author of the paper and a professor of radiation oncology, said: "The lymph nodes are often thought to be responsible for long-distance metastases. However, multiple retrospective and prospective studies have shown that complete resection of lymph nodes is not possible in many malignancies. Gaining a survival advantage. Our research provides the first direct genetic evidence to solve this mystery."
Co-author of the study, Dr. Jochen K. Lennerz of the Pathology District of Massachusetts General Hospital added: "Our traditional cancer assessment tools - typing, grading, and staging do not explain the relationship between cancer in multiple locations. Now, We have a new and effective way to observe the spread of cancer. Given the low cost and cost-effectiveness of this test, we are happy to send it to the clinic as soon as possible."
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