On the Origin of Syn- and Metachronous Urothelial Carcinomas.
Author
Summary, in English
Objective: To evaluate existing models for the origin of meta- and synchronous urothelial carcinomas in light of the accumulated genetic data. Methods: Published studies on the clonal origin and genetic relationships of syn- and metachronous tumors, genetic aberrations in normal and premalignant urothelial lesions, as well as histologic and genetic mapping studies of cystectomized bladder samples are reviewed. Results: The most common models for the origin of syn- and metachronous tumors are found to conform less well to the accumulated genetic data. A new model is proposed, the field-first-turnor-later model, in which aberrant cells with a stem cell, or stem cell-like, origin spread in the urothelium by cellular displacement, creating fields of premalignant cells. Tumor growth is suggested to be initiated by critical genetic events occurring in individual cells in such fields. Hence, recurring tumors are proposed to originate from a shared field of premalignant cells and not from previous overt tumors. Conclusions: The proposed model can better account for the existing genetic and histological data on syn- and metachronous urothelial carcinomas. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Department/s
Publishing year
2007
Language
English
Pages
1185-1193
Publication/Series
European Urology
Volume
51
Issue
5
Full text
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Document type
Journal article review
Publisher
Elsevier
Topic
- Urology and Nephrology
Keywords
- genetic changes
- urothelial carcinoma
- metachronous tumors
- tumor recurrence
- field cancerization
- intraepithelial migration
Status
Published
ISBN/ISSN/Other
- ISSN: 1873-7560