Patterns of metastases in adenocarcinomas of man. An autopsy study of 4,728 cases

This paper deals with 4,728 autopsy records collected at Roswell Park Memorial Institute, Department of Pathology. 1,436 adenocarcinomas provided the data to test whether certain adenocarcinomas had a higher propensity to seed metastatic organs than others. The data were subdiveded into four categories depending on the presence or absence of metastases at two keysites, i.e., lungs and liver. Metastatic keysites are defined as those organs whose chances of being seeded are the highest. Only adenocarcinomas were chosen to deal with the main theme discussed in the paper, i.e. soil specificity. "Soil specificity" is defined as a higher than expected occurrence of metastases at a particular organ, due to a primary adenocarcinoma, when compared to the overall group of adenocarcinomas. The location of the primary tumor and of the metastatic organ were taken into account to distinguish between a higher propensity to seed an organ either because of its anatomical proximity to the primary tumor or because of an affinity, possibly of biochemical nature. The presence or absence of metastases in lungs and liver clarifies the mode of spread of metastases, either by a direct spread, or by a cascade process which implies that no generalized metastases occur unless the lungs and liver are seeded.