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Liu G, Yang F, Gao L, Chen C, Wei J, Zheng Y, Mao F. Analysis of the metastatic mechanism and progress in the treatment of breast cancer liver metastasis: a narrative review. Transl Cancer Res 2023; 12:1635-1646. [PMID: 37434684 PMCID: PMC10331708 DOI: 10.21037/tcr-22-2463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/07/2023] [Indexed: 07/13/2023]
Abstract
Background and Objective Breast cancer is the most common malignancy in women, and metastasis to other target organs is one of the main causes of death. Breast cancer liver metastasis (BCLM) has long been a research focus. Enhancing therapeutic effects, optimizing treatment plans and improving the prognosis of patients are major clinical challenges at present. Methods We performed a comprehensive, nonsystematic review of the latest literature to define the current metastatic mechanism and related treatment advances of BCLM. Key Content and Findings Due to the lack of research on the mechanism of BCLM, present treatment programs still have limited benefits, and the prognosis of patients is generally poor. New research directions and treatment ideas for BCLM are urgently needed. In this article, we indicated the specific procedures of the BCLM mechanism from the microenvironment to metastasis formation and progress in treatment, including drug therapies such as targeted therapy, surgery, intervention therapy and radiotherapy. Research on the molecular mechanism plays a crucial role in the development of BCLM-related therapies. Based on the metastasis process, we are able to propel new findings and further progression of antineoplastic drugs. Conclusions The process of BCLM is multistep, and various factors are involved in it, which provides a powerful theoretical basis for the development of therapeutic methods for treatment of this disease. Further understanding of the mechanism of BCLM is essential to guide clinical management.
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Affiliation(s)
- Guanmo Liu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Yang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Gao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang Chen
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Wei
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongchang Zheng
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2
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Liu H, Li X, Li H, Feng L, Sun G, Sun G, Wu L, Hu Y, Liu L, Wang H. Potential molecular mechanisms and clinical progress in liver metastasis of breast cancer. Biomed Pharmacother 2022; 149:112824. [PMID: 35306430 DOI: 10.1016/j.biopha.2022.112824] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women and the leading cause of cancer death in women. About 30% of breast cancer patients have metastasis every year, which greatly increases the mortality rate of breast cancer. The main target organs for metastasis are bone, brain, liver and lung. The breast cancer liver metastasis (BCLM) mechanism is not fully clarified. This is a complex process involving multiple factors, which is not only related to the microenvironment of the primary tumor and liver, but also regulated by a variety of signaling pathways. Clarifying these mechanisms is of great help to guide clinical treatment. With the in-depth study of BCLM, a variety of new treatment schemes such as targeted therapy and endocrine therapy provide new ideas for the cure of BCLM. In this review, we will summarize the molecular mechanism and treatment of BCLM.
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Affiliation(s)
- Hanyuan Liu
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao Li
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiyang Li
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Feng
- School of Public Health, Fudan University, Shanghai, China
| | - Guangshun Sun
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guoqiang Sun
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liangliang Wu
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Hu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
| | - Li Liu
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Hanjin Wang
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
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Al-Mohaya MA, Alfadhel AK, Mustafa M, Alquwayz TS, Al-Anazi MA. Vascular endothelial growth factor (VEGF-2578 C > A) gene polymorphism as a genetic biomarker for breast cancer: A case control study. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2020.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Singh S, Shukla R. Key Signaling Pathways Engaged in Cancer Management: Current Update. CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394714666180904122412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
<P>Background: Till today cancer is still challenging to treat and needs more active therapeutic approaches. Participation of complex multi-pathway cell propagation instrument is a noteworthy issue in creating active anticancer therapeutic methodologies. Immune evasions, metabolic modifications, imperfect apoptotic component, modification in upstream or downstream RAS signaling, altered nuclear factor kappa B actions, imbalanced autophagy design and distortedly controlled angiogenesis are distinguishing features of cancer. </P><P> Methods: On the basis of systemic research and analysis of the current online available database, we analyzed and reported about the key signaling pathway engaged with cancer development outlining the effectiveness of different therapeutic measures and targets that have been created or are being researched to obstruct the cancer development. </P><P> Results: A number of signaling pathways, for example, resistant, metabolism, apoptosis, RAS protein, nuclear factor kappa B, autophagy, and angiogenesis have been perceived as targets for drug treatment to control the advancement, development and administration of cancer. </P><P> Conclusion: A noteworthy challenge for future medication advancement is to detail a synthesis treatment influencing distinctive targets to enhance the treatment of cancer.</P>
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Affiliation(s)
- Sanjiv Singh
- National Institute of Pharmaceutical Science and Education, Shree Bhawani Paper Mill Road, ITI Compound, Raebareli-229010 (U.P.), India
| | - Rahul Shukla
- National Institute of Pharmaceutical Science and Education, Shree Bhawani Paper Mill Road, ITI Compound, Raebareli-229010 (U.P.), India
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5
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deSouza NM, Tempany CM. A risk-based approach to identifying oligometastatic disease on imaging. Int J Cancer 2018; 144:422-430. [PMID: 30098215 PMCID: PMC6492106 DOI: 10.1002/ijc.31793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/27/2018] [Accepted: 07/31/2018] [Indexed: 12/14/2022]
Abstract
Recognition of <3 metastases in <2 organs, particularly in cancers with a known predisposition to oligometastatic disease (OMD) (colorectal, prostate, renal, sarcoma and lung), offers the opportunity to focally treat the lesions identified and confers a survival advantage. The reliability with which OMD is identified depends on the sensitivity of the imaging technique used for detection and may be predicted from phenotypic and genetic factors of the primary tumour, which determine metastatic risk. Whole‐body or organ‐specific imaging to identify oligometastases requires optimization to achieve maximal sensitivity. Metastatic lesions at multiple locations may require a variety of imaging modalities for best visualisation because the optimal image contrast is determined by tumour biology. Newer imaging techniques used for this purpose require validation. Additionally, rationalisation of imaging strategies is needed, particularly with regard to timing of imaging and follow‐up studies. This article reviews the current evidence for the use of imaging for recognising OMD and proposes a risk‐based roadmap for identifying patients with true OMD, or at risk of metastatic disease likely to be OM.
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Affiliation(s)
- Nandita M deSouza
- Cancer Research UK Imaging Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Clare M Tempany
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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Sourdon J, Lager F, Viel T, Balvay D, Moorhouse R, Bennana E, Renault G, Tharaux PL, Dhaun N, Tavitian B. Cardiac Metabolic Deregulation Induced by the Tyrosine Kinase Receptor Inhibitor Sunitinib is rescued by Endothelin Receptor Antagonism. Theranostics 2017; 7:2757-2774. [PMID: 28824714 PMCID: PMC5562214 DOI: 10.7150/thno.19551] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/31/2017] [Indexed: 02/06/2023] Open
Abstract
The growing field of cardio-oncology addresses the side effects of cancer treatment on the cardiovascular system. Here, we explored the cardiotoxicity of the antiangiogenic therapy, sunitinib, in the mouse heart from a diagnostic and therapeutic perspective. We showed that sunitinib induces an anaerobic switch of cellular metabolism within the myocardium which is associated with the development of myocardial fibrosis and reduced left ventricular ejection fraction as demonstrated by echocardiography. The capacity of positron emission tomography with [18F]fluorodeoxyglucose to detect the changes in cardiac metabolism caused by sunitinib was dependent on fasting status and duration of treatment. Pan proteomic analysis in the myocardium showed that sunitinib induced (i) an early metabolic switch with enhanced glycolysis and reduced oxidative phosphorylation, and (ii) a metabolic failure to use glucose as energy substrate, similar to the insulin resistance found in type 2 diabetes. Co-administration of the endothelin receptor antagonist, macitentan, to sunitinib-treated animals prevented both metabolic defects, restored glucose uptake and cardiac function, and prevented myocardial fibrosis. These results support the endothelin system in mediating the cardiotoxic effects of sunitinib and endothelin receptor antagonism as a potential therapeutic approach to prevent cardiotoxicity. Furthermore, metabolic and functional imaging can monitor the cardiotoxic effects and the benefits of endothelin antagonism in a theranostic approach.
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Affiliation(s)
- Joevin Sourdon
- Paris Cardiovascular Research Center (PARCC); INSERM UMR970; Université Paris Descartes; Paris, France
| | - Franck Lager
- Institut Cochin, Université Paris Descartes, INSERM U1016, Paris 75014, France
| | - Thomas Viel
- Paris Cardiovascular Research Center (PARCC); INSERM UMR970; Université Paris Descartes; Paris, France
| | - Daniel Balvay
- Paris Cardiovascular Research Center (PARCC); INSERM UMR970; Université Paris Descartes; Paris, France
| | - Rebecca Moorhouse
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Evangeline Bennana
- Institut Cochin, Université Paris Descartes, INSERM U1016, Paris 75014, France
- 3P5 proteomics facility, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
| | - Gilles Renault
- Institut Cochin, Université Paris Descartes, INSERM U1016, Paris 75014, France
| | - Pierre-Louis Tharaux
- Paris Cardiovascular Research Center (PARCC); INSERM UMR970; Université Paris Descartes; Paris, France
| | - Neeraj Dhaun
- University/British Heart Foundation Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Bertrand Tavitian
- Paris Cardiovascular Research Center (PARCC); INSERM UMR970; Université Paris Descartes; Paris, France
- Service de Radiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Eccles SA, Court W, Patterson L. In Vitro Assays for Endothelial Cell Functions Required for Angiogenesis: Proliferation, Motility, Tubular Differentiation, and Matrix Proteolysis. Methods Mol Biol 2016; 1430:121-147. [PMID: 27172950 DOI: 10.1007/978-1-4939-3628-1_8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This chapter deconstructs the process of angiogenesis into its component parts in order to provide simple assays to measure discrete endothelial cell functions. The techniques described will be suitable for studying stimulators and/or inhibitors of angiogenesis and determining which aspect of the process is modulated. The assays are designed to be robust and straightforward, using human umbilical vein endothelial cells, but with an option to use other sources such as microvascular endothelial cells from various tissues or lymphatic endothelial cells. It must be appreciated that such reductionist approaches cannot cover the complexity of the angiogenic process as a whole, incorporating as it does a myriad of positive and negative signals, three-dimensional interactions with host tissues and many accessory cells including fibroblasts, macrophages, pericytes and platelets. The extent to which in vitro assays predict physiological or pathological processes in vivo (e.g., wound healing, tumor angiogenesis) or surrogate techniques such as the use of Matrigel™ plugs, sponge implants, corneal assays etc remains to be determined.
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Affiliation(s)
- Suzanne A Eccles
- Cancer Research UK Cancer Therapeutics Unit, Centre for Cancer Imaging, The Institute of Cancer Research, Cotswold Rd., Sutton, Surrey, SM2 5NG, UK.
| | - William Court
- Cancer Research UK Cancer Therapeutics Unit, Centre for Cancer Imaging, The Institute of Cancer Research, Cotswold Rd., Sutton, Surrey, SM2 5NG, UK
| | - Lisa Patterson
- Cancer Research UK Cancer Therapeutics Unit, Centre for Cancer Imaging, The Institute of Cancer Research, Cotswold Rd., Sutton, Surrey, SM2 5NG, UK
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8
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Lin Y, Liu F, Fan Y, Qian X, Lang R, Gu F, Gu J, Fu L. Both high expression of pyruvate kinase M2 and vascular endothelial growth factor-C predicts poorer prognosis in human breast cancer. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:8028-37. [PMID: 26339369 PMCID: PMC4555697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/28/2015] [Indexed: 06/05/2023]
Abstract
Pyruvate kinase M2 (PKM2) and vascular endothelial growth factor-C (VEGF-C) have been known to play an important role in tumorigenesis and tumor progression in breast cancer. However, the association between PKM2 and VEGF-C in breast cancer remains unclear. In the present study, a total of 218 specimens from breast cancer patients and 26 paired breast tumors with adjacent normal tissues as well as two breast cancer cell lines were enrolled to investigate the correlation between PKM2 and VEGF-C. We found that PKM2 and VEGF-C mRNA levels were both significantly increasing in breast tumors compared with adjacent normal tissues. Knockdown of PKM2 mRNA expression resulted in VEGF-C mRNA and protein down-regulated as well as cell proliferation inhibited. A positive correlation between PKM2 and VEGF-C expression was identified by immunohistochemical analyses of 218 specimens of patients with breast cancer (P=0.023). PKM2 high expression was significantly correlated with histological grade (P=0.030), lymph node stage (P=0.001), besides VEGF-C high expression was significantly associated with lymphovascular invasion (P=0.012). While combined high expression of PKM2 and VEGF-C was found to be associated with worse histological grade, more lymph node metastasis, more lymphovascular invasion, shorter progression free survival (PFS), and poorer overall survival (OS) in human breast cancer. The results of the present study suggested that PKM2 expression was correlated with VEGF-C expression, and combination of PKM2 and VEGF-C levels had the better prognostic significance in predicting the poor outcome of patients with breast cancer.
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MESH Headings
- Adult
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/enzymology
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/enzymology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Cell Line, Tumor
- Disease-Free Survival
- Female
- Gene Expression Regulation, Enzymologic
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- Kaplan-Meier Estimate
- Lymphatic Metastasis
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Proportional Hazards Models
- RNA Interference
- RNA, Messenger/metabolism
- Risk Factors
- Thyroid Hormones/genetics
- Thyroid Hormones/metabolism
- Time Factors
- Transfection
- Up-Regulation
- Vascular Endothelial Growth Factor C/genetics
- Vascular Endothelial Growth Factor C/metabolism
- Thyroid Hormone-Binding Proteins
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Affiliation(s)
- Yang Lin
- Department of Breast Cancer Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of CancerTianjin 300060, China
| | - Fangfang Liu
- Department of Breast Cancer Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of CancerTianjin 300060, China
| | - Yu Fan
- Department of Breast Cancer Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of CancerTianjin 300060, China
| | - Xiaolong Qian
- Department of Breast Cancer Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of CancerTianjin 300060, China
| | - Ronggang Lang
- Department of Breast Cancer Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of CancerTianjin 300060, China
| | - Feng Gu
- Department of Breast Cancer Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of CancerTianjin 300060, China
| | - Jun Gu
- New York State Department of Health, Wadsworth Center, and School of Public Health, State University of New York at AlbanyNY 12201, United States
| | - Li Fu
- Department of Breast Cancer Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of CancerTianjin 300060, China
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Ma R, Feng Y, Lin S, Chen J, Lin H, Liang X, Zheng H, Cai X. Mechanisms involved in breast cancer liver metastasis. J Transl Med 2015; 13:64. [PMID: 25885919 PMCID: PMC4440291 DOI: 10.1186/s12967-015-0425-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/30/2015] [Indexed: 12/25/2022] Open
Abstract
Liver metastasis is a frequent occurrence in patients with breast cancer; however, the available treatments are limited and ineffective. While liver-specific homing of breast cancer cells is an important feature of metastasis, the formation of liver metastases is not random. Indeed, breast cancer cell factors contribute to the liver microenvironment. Major breakthroughs have been achieved recently in understanding breast cancer liver metastasis (BCLM). The process of liver metastasis consists of multiple steps and involves various factors from breast cancer cells and the liver microenvironment. A further understanding of the roles of breast cancer cells and the liver microenvironment is crucial to guide future work in clinical treatments. In this review we discuss the contribution of breast cancer cells and the liver microenvironment to liver metastasis, with the aim to improve therapeutic efficacy for patients with BCLM.
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Affiliation(s)
- Rui Ma
- Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou, Zhejiang, 310027, China.
| | - Yili Feng
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Shuang Lin
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Jiang Chen
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Hui Lin
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Xiao Liang
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Heming Zheng
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
| | - Xiujun Cai
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China.
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