The role of multiple somatic point mutations in metastatic progression.

To test the hypothesis that the ability to metastasize is determined by multiple point mutations during the expansion of a neoplastic clone, a mathematical model for sequential mutations was derived. Development of the metastatic phenotype was attributed to the mutation of a specific group of genes. The average tumor size was estimated for when a cell should manifest a set number of these mutated genes. In a tumor of 10(9) cells subject to 10(-6) mutations/gene per generation, only one of these genes, on average, should have mutated. To explain the multiplicity of changes associated with the metastatic phenotype, genetic variation at rates greater than 10(-3) variations/gene per generation seems necessary. Possible mechanisms for this variation involve gene amplification, chromosomal aneuploidy, and altered gene regulation rather than point mutation.