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Parallel progression of primary tumours and metastases

Abstract

Systemic cancer progression is accounted for in two basic models. The prevailing archetype places the engine of cancer progression within the primary tumour before metastatic dissemination of fully malignant cells. The second posits parallel, independent progression of metastases arising from early disseminated tumour cells. This Perspective draws together data from disease courses, tumour growth rates, autopsy studies, clinical trials and molecular genetic analyses of primary and disseminated tumour cells in support of the parallel progression model. Consideration of this model urges review of current diagnostic and therapeutic routines.

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Figure 1: Late dissemination and metastatic cascade model (breast cancer).
Figure 2: Parallel progression model (breast cancer).
Figure 3: Growth rates in human cancer.
Figure 4: Consequences of the two models for therapy research and clinical decisions.

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Acknowledgements

I thank D. Hölzel for insightful discussions about data from the Munich tumour registry and mathematical modelling of cancer progression. I am indebted to A. Perry for his critical reading of the manuscript and his invaluable suggestions to improve my English. I thank S. Pausch for her help with the figures. Finally, I thank all present and former members of the team for their enthusiastic work and our daily discussions. This work was supported by the Bavarian State Ministry of Sciences, Research and the Arts.

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Klein, C. Parallel progression of primary tumours and metastases. Nat Rev Cancer 9, 302–312 (2009). https://doi.org/10.1038/nrc2627

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