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1、ThenewenglandjournalofmedicinereviewarticleMolecularOriginsofCancerMolecularBasisofMetastasisAnneC.Chiang,M.D.,Ph.D.,andJoanMassagué,Ph.D.FromtheDepartmentofMedicine(A.C.C.),etastasisistheendproductofanevolutionaryprocessintheCancerBiologyandGeneticsProgramwhichdiverseinteractionsbetweencancerc
2、ellsandtheirmicroenviron-(J.M.),andtheHowardHughesMedicalMInstitute(J.M.),MemorialSloan-KetteringmentyieldalterationsthatallowthesecellstotranscendtheirprogrammedCancerCenter,NewYork.Addressreprintbehavior.Tumorcellsthuspopulateandflourishinnewtissuehabitatsand,ulti-requeststoDr.MassaguéatBox11
3、6,Me-mately,causeorgandysfunctionanddeath.Understandingthemanymolecularplay-morialSloan-KetteringCancerCenter,1275YorkAve.,NewYork,NY10065,orersandprocessesinvolvedinmetastasiscouldleadtoeffective,targetedapproachesatmassaguj@mskcc.org.topreventandtreatcancermetastasis.Thetumor–node–metastasis(
4、TNM)stagingsystemusedformostsolidtumorsNEnglJMed2008;359:2814-23.considersthetumorsizeanddegreeoflocalinvasion(T),thenumber,size,andCopyright©2008MassachusettsMedicalSociety.locationoflymphnodes(N),andthepresenceorabsenceofdistantmetastases(M).1Metastasesoftumorsoriginatingindifferentsites,such
5、asthebreastorlung,aretreateddifferentlybecausetheyarethoughttobehavelikethetissueoforigin,withcharacteristicpatternsandkineticsofspread,anddistinctprofilesofchemo-sensitivity.Lymphnodesareofparamountimportanceincurrentstagingpractices,butitishardtointerprettheclinicalsignificanceofthedistanceof
6、metastasesfromtheprimarysite(e.g.,asupraclavicularN3vs.amediastinalN2lymphnodeinlungcancer).Indeed,thedistancefromtheprimarytumortotheorganofmetas-tasisdoesnotaffectstaging.Forthisreason,therealvalueofstagingistoserveasanindicatoroftheprimarycancer’scompositecapabilitytometastasize,ratherthanto
7、ensurethatthetumorlieswithintheprescribedlimitsofalocalinter-vention.RecentadvancesbringhopeforcharacterizingthemetastaticbehaviorofcancercellsbeyondthesimplisticTNMstage.Inthefuture,stagingcouldincludeidentificationofsubpopulatio
