From COPD to Smoke-Related Arteriopathy: The Mechanic and Immune-Inflammatory Landscape Underlying Lung Cancer Distant Spreading. A Narrative Review
Abstract
Metastatic dissemination defines a complex phenomenon driven by genetic forces and importantly determined by interaction between cancer cells and the surrounding stroma. Although the biologic and immune reactions which characterize the process have been widely and extensively evaluated, fewer data are available regarding the mechanic and physical forces to which circulating neoplastic clones are exposed. It should be hypothesized that this interaction can be modified in case of concomitant pathologic conditions, such as chronic vasculopathy which frequently occurs in lung cancer patients. We here aim at analysing and discussing the complex interplay between lung malignant transformation and artheriopathy, mainly focusing on the immune-inflammatory sistemic reaction. Notably - in most instances – smoking history and a consequent chronic obstructive pulmonary disease cohexists. A main attention is payed to the analysis of the role of immunecheckpoint inhibitors and their interaction with triple bronchodilation and antiaggreagants. Understanding the biomechanical and molecular dynamics of lung cancer progression in altered vascular territories has several translational implications in defining risk stratification, in surgical planning and therapeutic targeting: Moreover, computational modelling of the physical forces which regulate the transit and extravasation of metastatic clones in altered contexts could be of help in deciphering the whole process and in determining more…
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