Heenen M, Laporte M
Département de Dermatologie, Hôpital Erasme, Université Libre de Bruxelles, Belgique.
Ann Dermatol Venereol. 2003 Nov;130(11):1025-31.
Melanoma prognosis is based on histological criteria such as tumor thickness (measured by Breslow index), level of invasion (Clarck's level), presence of ulceration and number of mitoses per mm2. However, these parameters do not provide a precise prognosis in all cases: thin melanomas may develop metastases and thick melanomas may remain focalized for many years. For these reasons, the search for other prognostic factors is still ongoing. Many molecules play a part in the invasiveness and metastatic dissemination of melanoma have now been identified. Expression of these molecules has been studied in primary melanoma and correlated with prognosis. An increase in the number of cells positive for Ki67 (detected by Mib1), cycline A, cycline D, p35, MMp-2, beta1 and beta3 integrins, osteonectin, the presence of an intense inflammatory infiltrate and capillary invasion are considered as factors of poor prognosis as well as the decrease in p16, p27, Melan A and nm23. The significance of CD44 modifications is still controversial. Only a small number of these different proteins has a prognostic value independent of tumor thickness. These results need to be confirmed on larger series of patients. Additional hope is given to new techniques such as the analysis of the genes implied in tumor progression by microarray technique in such a way as to provide a molecular map of each tumor.
黑色素瘤的预后基于组织学标准，如肿瘤厚度（通过 Breslow 指数测量）、浸润水平（克拉克水平）、溃疡的存在以及每平方毫米的有丝分裂数。然而，这些参数并非在所有情况下都能提供精确的预后：薄的黑色素瘤可能发生转移，而厚的黑色素瘤可能多年保持局限性。基于这些原因，对其他预后因素的探索仍在继续。现已确定许多分子在黑色素瘤的侵袭和转移扩散中起作用。这些分子的表达已在原发性黑色素瘤中进行研究，并与预后相关联。Ki67（通过 Mib1 检测）、细胞周期蛋白 A、细胞周期蛋白 D、p35、基质金属蛋白酶 -2、β1 和 β3 整合素、骨连接蛋白阳性细胞数量的增加，强烈炎症浸润和毛细血管侵袭的存在以及 p16、p27、黑色素 A 和 nm23 的减少都被视为预后不良的因素。CD44 修饰的意义仍存在争议。这些不同蛋白质中只有少数具有独立于肿瘤厚度的预后价值。这些结果需要在更多患者系列中得到证实。通过微阵列技术分析肿瘤进展中涉及的基因等新技术带来了额外的希望，以便提供每个肿瘤的分子图谱。
