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Significance Latent tumor cells are the crucial reason of tumor recurrence and the death of cancer patients. Preventing latent tumor relapse can prolong patients’ survival and have a long time surviving with latent tumor cells. Here, we describe a lung cancer suspensive tumor model in mouse and find that a high level of cancer stem cells undergoing asymmetric cell division in latent tumor is the key issue to reactivate a suspensive tumor. The results clearly delineate the state of latent tumor in vivo. A high level of serum IGF-1 can induce the suspensive-to-progressive tumor transition though promoting CSCs symmetric division, which illuminate a key checkpoint of cancer relapse before angiogenesis, highlighting a potential therapeutic target for preventing tumor recurrence.

Expansion of cancer stem cell pool initiates lung cancer recurrence before angiogenesis