Lai Hong, Ma Fangchao, Lai Shenghan
Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
J Cell Biochem. 2003 Jan 1;88(1):121-7. doi: 10.1002/jcb.10283.
Cancer of the eye, though relatively rare, can involve multiple areas. Retinoblastoma is the most common primary intraocular cancer in children, with 3-7 cases per million people per year worldwide. Uveal melanoma is the most common primary intraocular cancer in adults, predominately in whites, with annual incidence of six per million people in the United States and Europe. Despite the rarity of retinoblastoma, Knudson's two-hit hypothesis to explain its genesis was substantiated by elegant genetic studies and is viewed as a turning point in cancer research. pRB plays an important role in cell cycle and apoptosis, performing its function through interaction with transcription factors, p53, and MDM2. Unfortunately, advances in eye cancer treatment have not paralleled those in treatment of other sites of cancer. In spite of higher accuracy in early diagnosis, eye-cancer-specific mortalities have remained unchanged for decades, while overall cancer mortality rates have dramatically declined. An extensive literature search revealed that, except for retinoblastoma, few investigations had been done on the pRB pathway in eye cancers even though altered pRB expression has been associated with a number of cancers. Early detection of eye cancer is critical for the prognosis of both vision and survival. Mutation analysis should become an integral part of future management of patients with eye cancer. Characterization of the mutational pattern of RB1 is crucial in identifying predisposition for cancer of many sites including the eye. Furthermore, cost-effective and efficient genetic mutation screen testing methods, which can be used to categorize mutant RB1 carriers, are needed. Illumination of genetic insights can guide clinicians to develop a rational strategy for cancer treatment and help predict prognosis in cancer patients.
眼癌虽然相对罕见,但可累及多个部位。视网膜母细胞瘤是儿童最常见的原发性眼内癌,全球每年每百万人中有3 - 7例。葡萄膜黑色素瘤是成人最常见的原发性眼内癌,主要发生在白人中,在美国和欧洲每年发病率为每百万人中有6例。尽管视网膜母细胞瘤罕见,但克努森的双打击假说来解释其发生机制已通过精细的遗传学研究得到证实,并被视为癌症研究的一个转折点。pRB在细胞周期和细胞凋亡中起重要作用,通过与转录因子、p53和MDM2相互作用发挥其功能。不幸的是,眼癌治疗的进展并未与其他部位癌症的治疗进展同步。尽管早期诊断的准确性更高,但几十年来眼癌特异性死亡率一直没有变化,而总体癌症死亡率却大幅下降。广泛的文献检索显示,除了视网膜母细胞瘤外,尽管pRB表达改变与多种癌症有关,但针对眼癌中pRB通路的研究很少。眼癌的早期检测对于视力和生存预后至关重要。突变分析应成为未来眼癌患者管理的一个组成部分。RB1突变模式的特征对于确定包括眼在内的许多部位癌症的易感性至关重要。此外,需要具有成本效益且高效的基因突变筛查检测方法,可用于对RB1突变携带者进行分类。遗传学见解的阐明可指导临床医生制定合理的癌症治疗策略,并有助于预测癌症患者的预后。