Taussig Cancer Institute, Cleveland Clinic Foundation, Ohio, USA.
Future Oncol. 2011 Jan;7(1):101-9. doi: 10.2217/fon.10.143.
Despite advances in the diagnosis and local tumor control, the overall mortality rate for uveal melanoma remains high because of the development of metastatic disease. The clinical and histopathological systems currently being used to classify patients are not sufficiently accurate to predict metastasis. Tumor genotyping has demonstrated significant promise but obtaining tumor tissue can be problematic. Furthermore, assessment of tumor tissue does not indicate whether tumor cells have actually been shed and cannot indicate whether treatment is reducing metastasis. The detection of circulating tumor cells in blood has been shown to be a prognostic biomarker that can be used to monitor the effectiveness of therapy in patients with metastatic carcinoma. Uveal melanoma disseminates hematogenously, and the detection of circulating melanoma cells may potentially be useful for diagnosis, risk stratification, and the monitoring of disease progression and treatment efficacy. PCR-based and immunomagnetic cell isolation techniques, derived from studies in patients with cutaneous melanoma, have been tested. For various biological and technical reasons, they have not demonstrated the accuracy and reproducibility required for an effective prognostic assay in patients with uveal melanoma. Assessments have been confounded by false positives and negatives and thus, correlations between circulating melanoma cells and survival have not yet been established. Circulating melanoma cell detection is a valuable tool for investigating metastasis in uveal melanoma and also has the potential to become a standard part of uveal melanoma management. However, more research on the biology of uveal melanoma as well as improvements upon the current technologies are needed.
尽管在诊断和局部肿瘤控制方面取得了进展，但葡萄膜黑色素瘤的总体死亡率仍然很高，因为会发生转移性疾病。目前用于对患者进行分类的临床和组织病理学系统不够准确，无法预测转移。肿瘤基因分型已显示出巨大的潜力，但获取肿瘤组织可能存在问题。此外，对肿瘤组织的评估并不能表明肿瘤细胞是否已经脱落，也不能表明治疗是否正在减少转移。在血液中检测循环肿瘤细胞已被证明是一种预后生物标志物，可用于监测转移性癌患者的治疗效果。葡萄膜黑色素瘤通过血液传播，检测循环黑色素瘤细胞可能对诊断、风险分层以及监测疾病进展和治疗效果有用。已经测试了基于 PCR 和免疫磁细胞分离技术，这些技术源自对皮肤黑色素瘤患者的研究。由于各种生物学和技术原因，它们没有表现出在葡萄膜黑色素瘤患者中进行有效预后检测所需的准确性和可重复性。评估受到假阳性和假阴性的影响，因此，循环黑色素瘤细胞与生存之间的相关性尚未建立。循环黑色素瘤细胞检测是研究葡萄膜黑色素瘤转移的有价值工具，也有可能成为葡萄膜黑色素瘤管理的标准组成部分。然而，需要对葡萄膜黑色素瘤的生物学进行更多研究，并改进当前的技术。
