Kaštelan Snježana, Mrazovac Zimak Danijela, Ivanković Mira, Marković Irena, Gverović Antunica Antonela
School of Medicine Univerity of Zagreb, Department of Ophthalmology, University Hospital Dubrava, 10000 Zagreb, Croatia.
Department of Ophthalmology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Front Biosci (Landmark Ed). 2022 Feb 21;27(2):72. doi: 10.31083/j.fbl2702072.
Uveal melanoma (UM) is the most prevalent primary intraocular malignancy in adults with a stable incidence rate between five and seven cases per million in Europe and the United States. Although UM and melanoma from other sites have the same origin, UM has different epidemiological, biological, pathological and clinical features including characteristic metastatic hepatotropism. Despite improvements in the treatment of primary tumours, approximately 50% of patients with UM will develop metastases. In 90% of cases the liver is the first site of metastasis, however the mechanisms underlying this hepatic tropism have not been elucidated. Metastatic disease is associated with a very poor prognosis with a median overall survival of 6 to 12 months. Currently, there is no standard systemic treatment available for metastatic UM and once liver metastases have developed, prognosis is relatively poor. In order to prolong survival, close follow-up in all patients with UM is recommended for early detection and treatment. The treatment of metastatic UM includes systemic chemotherapy, immunotherapy and molecular targeted therapy. Liver-directed therapies, such as resection, radioembolization, chemoembolization, immunoembolization, isolated and percutaneous liver perfusion as well as thermal ablation represent available treatment options. However, to date a consensus regarding the optimal method of treatment is still lacking and the importance of setting guidelines in the treatment and management of metastatic UM is becoming a priority. Improvement in knowledge and a better insight into tumour biology, immunology and metastatic mechanism may improve current treatment methods and lead to the development of new strategies paving the way for a personalized approach.
葡萄膜黑色素瘤（UM）是成人中最常见的原发性眼内恶性肿瘤，在欧洲和美国，其发病率稳定在每百万人中有5至7例。尽管UM与其他部位的黑色素瘤起源相同，但UM具有不同的流行病学、生物学、病理学和临床特征，包括特征性的肝转移倾向。尽管原发性肿瘤的治疗有所改善，但约50%的UM患者会发生转移。在90%的病例中，肝脏是第一个转移部位，然而这种肝转移倾向的潜在机制尚未阐明。转移性疾病的预后非常差，中位总生存期为6至12个月。目前，对于转移性UM尚无标准的全身治疗方法，一旦发生肝转移，预后相对较差。为了延长生存期，建议对所有UM患者进行密切随访，以便早期发现和治疗。转移性UM的治疗包括全身化疗、免疫治疗和分子靶向治疗。肝脏定向治疗，如切除、放射性栓塞、化学栓塞、免疫栓塞、孤立性经皮肝脏灌注以及热消融，都是可用的治疗选择。然而，迄今为止，关于最佳治疗方法仍缺乏共识，为转移性UM的治疗和管理制定指南的重要性正成为当务之急。对肿瘤生物学、免疫学和转移机制的认识提高和更深入了解，可能会改善当前的治疗方法，并导致新策略的开发，为个性化治疗方法铺平道路。
