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Science:双重磅实锤来了!美奥两国团队分别独立证实,转移到淋巴结的癌细胞可以再次产生远处转移灶

2018-03-24 谭硕 奇点网

即使同是癌症病房,也会有悲喜两重天,而患者和家属最怕从医生口中听到的,大概就是“转移”两个字吧。中年男人当场晕倒在地,新婚小夫妇互相抱头痛哭,这样的场景可不是影视剧里的杜撰。而如果转移前面多了“淋巴结”三个字,医生和患者大概都会长舒一口气:还好没有远处转移,有根治的机会。

即使同是癌症病房,也会有悲喜两重天,而患者和家属最怕从医生口中听到的,大概就是“转移”两个字吧。中年男人当场晕倒在地,新婚小夫妇互相抱头痛哭,这样的场景可不是影视剧里的杜撰。而如果转移前面多了“淋巴结”三个字,医生和患者大概都会长舒一口气:还好没有远处转移,有根治的机会。

然而奇点糕又要说“但是”了。这是个反转每天都在上演的年代,120码生死时速的事疑点都那么多,癌细胞乖乖在淋巴结里看戏就更是假象了。今天的《科学》上,美国和奥地利的研究团队分别证明,淋巴结里的癌细胞能跳出淋巴结侵入血管,独立发生远处转移!真是道高一尺,魔高一丈啊……


癌细胞转移到淋巴结了就算完?太小看它们了吧……

真要聊起淋巴结与癌症的关系,奇点糕估计能扯出几千字的闲篇来……只说一点吧,国际通用的癌症TNM分期中的N,就是指区域淋巴结的转移状况。由于淋巴结的转移与患者预后关系密切,各种实体肿瘤的根治性手术中,切除区域淋巴结并送检也是必不可少的一环。

虽然医生们查体要摸淋巴结肿大,阅片要看淋巴结形态,手术要做淋巴结切除,但真要找个一线医生来问这么个问题,估计还真没多少人答得上:为什么淋巴结转移的患者,癌症复发和转移的风险会更高呢?就这么一个小小的问题,医学科研多年来却一直没能参透。

医生们认为淋巴结转移会导致患者预后更差,主要是依据经验和临床试验结果,但在讲究精准医疗的时代,这些证据已经有些不够了,尤其是近年来不断有临床试验显示,多切除淋巴结可能在延长患者生存期方面徒劳无功。没有机制层面上的实锤证明癌症转移到淋巴结有害,是不是该考虑收刀入鞘呢?


精准医学不止是靶向药物的药到病除,不该多做的治疗不做,不切的组织不切,也是精准的体现

为了证实淋巴结内的癌细胞存在远处转移能力,哈佛大学的研究团队用荧光蛋白标记了癌细胞,这种荧光蛋白一旦被特定波长的光束照射,发光就会不可逆地由绿变红。在将癌细胞注射到小鼠中20天后,切除原发肿瘤,再用光束照射小鼠的淋巴结,经过这样一番处理,发出红光的癌细胞,肯定是在淋巴结转移灶中受到了照射再转移出的,而散发绿光的癌细胞则来自原发肿瘤。

研究团队发现,不仅小鼠的血液中可检出红色的循环肿瘤细胞,肺内也已经形成了散发红光的转移灶,这就证明淋巴结内的癌细胞完全可以独挑大梁,产生致命的远处转移!进一步的分析显示,癌细胞还可以模仿免疫细胞在淋巴结中的运动模式,从而通过淋巴管系统实现扩散,真是无孔不入啊。


小鼠的淋巴结中既有红色又有绿色,说明直接扩散和经淋巴结转移的癌细胞都进入了转移灶

不过传统观点认为,癌细胞如果从淋巴结进一步扩散入血,要先随着淋巴液逐级回流到胸导管,再蔓延到相邻的锁骨下静脉,才能进入血液系统。走这么一条“最艰难的路”,真当癌细胞是几天不着家的蛙儿子吗?哈佛团队也在小鼠实验和患者的淋巴结中发现,癌细胞在淋巴结内还有着靠近血管分布的倾向。

精明的癌细胞,会不会真的选了直接从淋巴结转进到血管这条路呢?《科学》同期刊发的维也纳医科大学和奥地利科技学院团队的论文证实了这种猜想。与哈佛团队不同,奥地利科学家们将癌细胞注射到了小鼠的腘窝淋巴结中,在不破坏淋巴结正常结构的情况下,分析癌细胞如何在没有原发灶的情况下实现远处转移。

实验显示,癌细胞根本不需要再单独生成新的血管,只需要借助淋巴结内原有的,专门让淋巴细胞从血液进入淋巴结的“高内皮细胞微静脉”(HEVs),癌细胞3天之内就可以从淋巴结扩散入血再继续播散到肺,最迟只需要35天就能形成肺转移灶,速度和直接将癌细胞注射到小鼠体内基本相当!


注射到小鼠淋巴结内后,癌细胞会最先向肺部转移,最多只需要5个星期就形成转移灶

在荧光染色下的进一步实验显示,当80%小鼠的肺内已经能检测到转移的癌细胞时,淋巴液从腘窝回流必经之路上的髂淋巴结竟然查不到一个癌细胞……研究团队把小鼠下肢淋巴管系统结扎掉,发现癌细胞照样在注射后的第3天出现在了小鼠的肺部。随着淋巴回流?癌细胞才不玩这种慢动作!

哈佛大学团队的论文通讯作者,副教授Timothy Padera表示:“如果本次的发现在人体也得到证实,那么完全可以确认,某些淋巴结转移就是致命的癌症远处转移灶的源头。对具体的分子机制进行进一步分析,找到转移高危淋巴结的分子标记物,可以帮助医生确定必须对哪些淋巴结采取治疗。”

虽说两篇论文中,研究团队都表示这一结论还需要人体结果的确认,但奇点糕已经觉得背上冒出鸡皮疙瘩,又由春转冬了……能远程控制、能快速转移、还能耐受各种药物,癌细胞难道真的开了外挂,处处占尽先机吗?向投身于抗癌事业的各位科学家致敬,你们挑战的这个副本真的是地狱难度啊……

原始出处:

1.Pereira E R, Kedrin D, Seano G,et al. Lymph node metastases can invade local blood vessels, exit the node, and colonize distant organs in mice[J].  Science,  2018, 359(6382): 1403-1407.

2.Brown M, Assen F P, Leithner A, et al. Lymph node blood vessels provide exit routes for metastatic tumor cell dissemination in mice[J]. Science,  2018, 359(6382):1408-1411.

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    2018-04-23 zwjnj2

    好好学习学习天天向上

    0

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    2018-03-26 yxch36
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    2018-03-26 sodoo
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    2018-03-26 jichang
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    2018-03-26 xxxx1054
  8. [GetPortalCommentsPageByObjectIdResponse(id=1756555, encodeId=8f4e1e5655599, content=<a href='/topic/show?id=880d934525e' target=_blank style='color:#2F92EE;'>#转移灶#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93452, encryptionId=880d934525e, topicName=转移灶)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eb5637174268, createdName=ms6390871039024434, createdTime=Thu Sep 13 04:37:00 CST 2018, time=2018-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308578, encodeId=167a3085e840, content=好好学习学习天天向上, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Mon Apr 23 18:38:27 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1252481, encodeId=1cd0125248101, content=<a href='/topic/show?id=3efee1519b2' target=_blank style='color:#2F92EE;'>#癌细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71519, encryptionId=3efee1519b2, topicName=癌细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cea26, createdName=yxch36, createdTime=Mon Mar 26 11:37:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1293026, encodeId=bd0e12930265b, content=<a href='/topic/show?id=df626600877' target=_blank style='color:#2F92EE;'>#淋巴结#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66008, encryptionId=df626600877, topicName=淋巴结)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6cc1239, createdName=sodoo, createdTime=Mon Mar 26 11:37:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1375787, encodeId=b3d813e57879d, content=<a href='/topic/show?id=2949159989d' target=_blank style='color:#2F92EE;'>#SCIE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15998, encryptionId=2949159989d, topicName=SCIE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=17a3387, createdName=jichang, createdTime=Mon Mar 26 11:37:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423492, encodeId=06871423492a9, content=<a href='/topic/show?id=badd9441868' target=_blank style='color:#2F92EE;'>#远处转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94418, encryptionId=badd9441868, topicName=远处转移)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c42b3793913, createdName=hanhaisha2009, createdTime=Mon Mar 26 11:37:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549302, encodeId=ee19154930284, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Mon Mar 26 11:37:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=299316, encodeId=37e229931607, content=好文章.学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Mar 24 20:59:31 CST 2018, time=2018-03-24, status=1, ipAttribution=)]
    2018-03-24 1e0f8808m18(暂无匿称)

    好文章.学习了.

    0

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