BACKGROUND:
Metastasis formation
remains an enigmatic process and one of the main questions recently asked is
whether metastases are able to generate further metastases. Different models
have been proposed to answer this question; however, their clinical
significance remains unclear. Therefore a computer model was developed that
permits comparison of the different models quantitatively with clinical data
and that additionally predicts the outcome of treatment interventions.
METHODS:
The computer model is
based on discrete events simulation approach. On the basis of a case from an
untreated patient with hepatocellular carcinoma and its multiple metastases in
the liver, it was evaluated whether metastases are able to metastasise and in
particular if late disseminated tumour cells are still capable to form metastases.
Additionally, the resection of the primary tumour was simulated. The simulation
results were compared with clinical data.
RESULTS:
The simulation
results reveal that the number of metastases varies significantly between
scenarios where metastases metastasise and scenarios where they do not. In
contrast, the total tumour mass is nearly unaffected by the two different modes
of metastasis formation. Furthermore, the results provide evidence that
metastasis formation is an early event and that late disseminated tumour cells
are still capable of forming metastases. Simulations also allow estimating how
the resection of the primary tumour delays the patient's death.
CONCLUSION:
The simulation
results indicate that for this particular case of a hepatocellular carcinoma
late metastases, i.e., metastases from metastases, are irrelevant in terms of
total tumour mass. Hence metastases seeded from metastases are clinically
irrelevant in our model system. Only the first metastases seeded from the
primary tumour contribute significantly to the tumour burden and thus cause the
patient's death.
Source: Are metastases from metastases clinical relevant? Computer modelling of
cancer spread in a case of hepatocellular carcinoma. Bethge A, Schumacher U,
Wree A, Wedemann G. PLoS One. 2012;7(4):e35689.
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