Weinlich G
Clinical Department of Dermatology and Venerology, Innsbruck Medical University, Innsbruck, Austria.
G Ital Dermatol Venereol. 2009 Feb;144(1):27-38.
Malignant melanoma is one of the most aggressive human neoplasms and its incidence is still increasing. Prognoses for melanoma patients are currently based on statistical parameters. For estimating the risk for a possible progression and for overall survival, Breslow tumour thickness and the invasion level (Clark level) are the most established markers for melanomas at the time of the primary diagnosis. In thicker melanomas (>1 mm) the additional information about the status of the sentinel lymph-node (SLN) might be helpful. Nevertheless new prognostic parameters are needed, that will allow us to formulate more precise prognoses for the individual cases. The metallo-thionein family is a class of intracellular low-molecular-weight, cysteine-rich proteins with a high affinity for heavy-metal ions. They are involved in many (patho-) physiological processes and presumably play an important role in the carcinogenesis. In the last decades overexpression of immunohistochemically labelled metallothioneins (MTs) on paraffin-embedded tissues turned out as a highly significant prognostic marker in different tumours. This review summarizes the results of those studies, in which MT-overexpression was able to show a very high significance for progression and survival in melanoma patients. In contrast to most other progression markers, MT-overexpression is independent from tumour-thickness, and is highly specific even in thin (low risk) melanoma patients. Nowadays, in high risk melanoma patients sentinel lymph-node (SLN-) biopsy is performed, a surgical technique with predictive value for progression, the benefit of this procedure for the individual overall survival still remains unclear. In a study comparing SLN and MT-overexpression the results corroborate the validity of MT-overexpression in primary melanoma as a useful additional prognostic marker, accuracy is comparable although to some degree supplementary to the results of SLN biopsy.
恶性黑色素瘤是最具侵袭性的人类肿瘤之一，其发病率仍在上升。目前黑色素瘤患者的预后是基于统计参数。为了估计可能进展的风险和总体生存率，在初次诊断时，Breslow肿瘤厚度和浸润水平（Clark分级）是黑色素瘤最常用的标志物。对于较厚的黑色素瘤（>1mm），前哨淋巴结（SLN）状态的额外信息可能会有所帮助。然而，仍需要新的预后参数，以便我们能够为个体病例制定更精确的预后。金属硫蛋白家族是一类细胞内低分子量、富含半胱氨酸的蛋白质，对重金属离子具有高亲和力。它们参与许多（病理）生理过程，可能在致癌过程中起重要作用。在过去几十年中，免疫组织化学标记的金属硫蛋白（MTs）在石蜡包埋组织上的过表达已被证明是不同肿瘤中具有高度显著性的预后标志物。本综述总结了那些研究的结果，其中MT过表达对黑色素瘤患者的进展和生存显示出非常高的显著性。与大多数其他进展标志物不同，MT过表达与肿瘤厚度无关，即使在薄型（低风险）黑色素瘤患者中也具有高度特异性。如今，在高危黑色素瘤患者中进行前哨淋巴结（SLN）活检，这是一种对进展具有预测价值的手术技术，该手术对个体总体生存的益处仍不清楚。在一项比较SLN和MT过表达的研究中，结果证实了MT过表达在原发性黑色素瘤中作为一种有用的额外预后标志物的有效性，尽管在某种程度上补充了SLN活检的结果，但其准确性相当。
