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Timeline metastatic progression: in the wake of the « seed and soil » theory

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Abstract

Little is known about the natural history of cancer and its evolution to metastasis. Paget was the first to postulate the important role played by microenvironment in metastasis progression. Since, the concept of his “seed and soil” theory has been supported and confirmed. Understanding the chronology and natural course that underlie metastasis is mandatory to deepen this concept and to progress in the development of novel therapeutic strategies. A total of 413 patients who underwent treatment for brain metastasis (2013–2016) were included. The identification of previous and newly diagnosed metastasis was made during the clinical and imaging follow-up. We identified 910 metastases in our series. The 2-, 5-, and 10-year survival estimates were 80% (SD 2), 59.1% (3), and 36% (4), respectively. The median time for first metastasis, referred as metastasis-free survival (MFS) was 15.2 months (SD 1.47). MFS were determined for each metastasis location and were as follows: 7.2 months (SD 8.0) for bone, adrenal 8.4 months (SD 9.4) for adrenal, 13.2 months (SD 1.7) for brain, 14.6 months (SD 5.4) for liver, 25.7 months (SD 11.7) for pleura, 27.7 months (SD 15.9) for peritoneum, 29.8 months (SD 7.2) for spine, 30.2 months (SD 5.2) for lungs, and 54.2 months (SD 12.4) for skin (p < 0.009 log rank). We identified a metastatic timeline process for breast cancer (p < 0.0001 log rank (Mantel–Cox)) and furthermore according to breast subtype cancer (p < 0.0001). We suggest that in addition to Paget’s theory, a timeline and a natural history of metastasis exist in patients with cancer. We suppose that some, but not all, primary cancers follow chronological and scheduled metastatic processes to invade organs.

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Authors and Affiliations

  1. Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France

    Aymeric Amelot, Charles-Ambroise Valery, Philippe Cornu, Alexandre Carpentier & Marc Leveque

  2. Department of Neurosurgery, Hopital Bretonneau, Tours, France

    Aymeric Amelot & Louis-Marie Terrier

  3. Université Paris VI – Pierre et Marie Curie, Paris, France

    Jean-Jacques Mazeron, Charles-Ambroise Valery, Philippe Cornu, Alexandre Carpentier & Marc Leveque

  4. Department of Radiotherapy, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France

    Jean-Jacques Mazeron

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  1. Aymeric Amelot
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Contributions

AA, LMT, CAV, AC, ML, and JJM contributed to design and conceptualization of the study; AA, LMT, CAV, and PC analyzed the data; AA, LMT, AC, ML, and JJM interpreted the data; AA, LMT, AC, ML, JJM, and PC drafted the manuscript; AA, LMT, AC, and ML wrote the manuscript; AA, LMT, CAV, AC, ML, and JJM revised the manuscript for intellectual content; and AA and ML were responsible for the overall content as guarantor.

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Correspondence to Aymeric Amelot.

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Authors AA, LMT, JJM, CAV, AC, and ML declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Amelot, A., Terrier, LM., Mazeron, JJ. et al. Timeline metastatic progression: in the wake of the « seed and soil » theory. Med Oncol 34, 185 (2017). https://doi.org/10.1007/s12032-017-1045-8

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