Cited by 1,340Cancer, Hypoxia, and MetabolismMechanisms of cancer metastasisCancer Cells and Metastasis

The DOI matches its Crossref record; 116 of the 116 references it cites were found in a registry or an index; none of the 153 sources its claims cite is checked for support yet.

Hypoxic control of metastasis

Open access

Abstract

Metastatic disease is the leading cause of cancer-related deaths and involves critical interactions between tumor cells and the microenvironment. Hypoxia is a potent microenvironmental factor promoting metastatic progression. Clinically, hypoxia and the expression of the hypoxia-inducible transcription factors HIF-1 and HIF-2 are associated with increased distant metastasis and poor survival in a variety of tumor types. Moreover, HIF signaling in malignant cells influences multiple steps within the metastatic cascade. Here we review research focused on elucidating the mechanisms by which the hypoxic tumor microenvironment promotes metastatic progression. These studies have identified potential biomarkers and therapeutic targets regulated by hypoxia that could be incorporated into strategies aimed at preventing and treating metastatic disease.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes mechanisms by which hypoxia and HIF-1/HIF-2 signaling promote metastatic progression, from immune evasion and EMT to premetastatic niche formation and distant-site metabolic adaptation. It highlights candidate biomarkers and therapeutic targets, including AXL, LOX, exosomes, CKB, and PDK1.

Key findings

  • Metastatic disease is responsible for more than 90% of cancer-related deaths, and an estimated 50 to 60% of solid tumors contain regions of hypoxia and/or anoxia; clinically, hypoxia and HIF expression are associated with increased metastasis, therapy resistance, and poor survival.
  • HIF signaling influences multiple steps of the metastatic cascade, including immune evasion, EMT/invasion/migration, premetastatic niche formation, and growth/survival at distant sites; specific mediators discussed include AXL, LOX/LOXL2/4, exosomes, CKB, and PDK1.
  • In the liver, an oxygen gradient exists with periportal blood at 60 to 65 mm Hg and perivenous blood at 30 to 35 mm Hg; colon cancer cells adapt to hepatic hypoxia via CKB/phosphocreatine, and breast cancer liver metastases depend on glycolysis largely through the HIF-1 target PDK1.
  • High HIF-1 expression is associated with metastasis in gynecological, pancreatic, esophageal, lung, and prostate cancers, while HIF-2 expression is associated with distant metastasis in small cell lung and breast cancers; experimentally, HIF overexpression promotes metastasis and HIF inactivation decreases metastatic potential.

Methods

  • Design: narrative review of the literature on hypoxia, HIF signaling, and metastasis.
  • Data or sample: no primary dataset; the paper synthesizes clinical observations and preclinical models, including human tumor immunohistochemical analyses and mouse metastasis studies.
  • Main analysis: thematic synthesis of mechanisms by which hypoxia and HIF-dependent signaling regulate immune evasion, EMT, premetastatic niche formation, and distant-site colonization.

Limitations

  • Stated limitations: Not stated in the paper.
  • Evident limitations: as a narrative review, it does not describe a systematic search strategy, inclusion criteria, or quantitative synthesis, so selection bias is possible.
  • Evident limitations: many mechanistic conclusions rely on preclinical models and association studies in human tumors, which may not establish causality in patients.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1126/science.aaf4405

Cites

116 of 116 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 153 cited sources checked · 0 supported · 0 flagged

Show all 99 claims

  • It may state two separate claims as one. 27
  • Probably not a substantial claim. 5
32 of 32

Claims other papers make about this one

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Glycolytic liver zone identified inconsistently

    Minor

    The paper first places glycolysis predominantly in perivenous hepatocytes, but later attributes the liver's glycolytic phenotype to periportal regions.

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Citations

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Metadata

Authors
Rankin, E. B., & Giaccia, A. J.
Affiliations
Stanford Medicine (US)
Corresponding author
Giaccia, Amato J.
Venue
Science
Published
2016-04-08
Volume
352
Issue
6282
Pages
175-180
ISSN
  • 0036-8075 (ISSN-L)
  • 1095-9203
OpenAlex
W2323751645
Cited by
1,340
References
116
Citations by year
2026: 98 · 2025: 117 · 2024: 127 · 2023: 119 · 2022: 191 · 2021: 186 · 2020: 160 · 2019: 143 · 2018: 87 · 2017: 85 · 2016: 26
FWCI
47.32
Type
journal article
Language
en
Open access
Locations
  • Science (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • NIH (CA-198291, CA-67166, CA-197713)
  • Silicon Valley Foundation
  • Sydney Frank Foundation
  • Kimmelman Fund
  • Department of Defense Ovarian Cancer Research Academy (OC140611)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Mechanisms of cancer metastasis
  • Health Sciences › Medicine › Oncology › Cancer Cells and Metastasis
Keywords
tumor hypoxia, metastasis, hypoxia-inducible factor, HIF-1, HIF-2, tumor microenvironment, metastatic progression, biomarkers, therapeutic target, cancer therapy
MeSH terms
Endothelial PAS Domain-Containing Protein 1, Animals, Cell Movement, Humans, Neoplasm Invasiveness, Neoplasm Metastasis, Radiation Tolerance, Biomarkers, Tumor, Signal Transduction, Cell Hypoxia, Disease Progression, Drug Resistance, Neoplasm, Basic Helix-Loop-Helix Proteins, Hypoxia-Inducible Factor 1, alpha Subunit, Epithelial-Mesenchymal Transition, Tumor Microenvironment

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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