葡萄膜黑色素瘤是一种激素敏感性癌症吗？关于性激素和妊娠对葡萄膜黑色素瘤影响的综述
Is Uveal Melanoma a Hormonally Sensitive Cancer? A Review of the Impact of Sex Hormones and Pregnancy on Uveal Melanoma.
作者信息
Miller Manisha, Schoenfield Lynn, Abdel-Rahman Mohamed, Cebulla Colleen M
机构信息
Havener Eye Institute, Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
出版信息
Ocul Oncol Pathol. 2021 Sep;7(4):239-250. doi: 10.1159/000514650. Epub 2021 Apr 22.
BACKGROUND
Despite a higher incidence and worse prognosis of uveal melanoma (UM) in men, there have been many case reports of pregnant patients with aggressive UM. This has led researchers to explore the influence of sex hormones and pregnancy on the development and progression of UM and hormones as potential therapeutic targets.
SUMMARY
A systematic literature review was conducted. More work is needed to elucidate the basis of sex differences in UM incidence and survival. The evaluation of germline mutation would be beneficial in patients with UM presenting at a young age. Importantly, multiple studies reported no significant difference between the 5-year survival and 5-year metastasis-free survival rates between nonpregnant women with UM and pregnant women with UM. Multiple case-control studies disagree on how parity affects risk of UM. However, most studies agree that oral contraceptives and hormone replacement therapy have no effect on the incidence of UM. Current treatment strategies for pregnant patients with UM are discussed. Looking forward, this review reports recent research on targeted receptor-based chemotherapy, which is based on evidence of estrogen receptor (ER), estrogen-related receptor alpha (ERRα), and luteinizing hormone-releasing hormone (LHRH) receptor expression in UM.
KEY MESSAGES
Based on review of the literature, UM is not a contraindication to oral contraceptives, hormone replacement therapy, or pregnancy. Globe-sparing radiation can be used as a treatment option for pregnant patients. Due to the presence of ER on a subset of unselected UM, its potential for adjunctive targeted therapy with agents like tamoxifen should be explored. Lessons from cutaneous melanoma regarding tissue ratios of estrogen receptors (ERα:ERβ) should be applied to assess their therapeutic predictive value. In addition, ERRα-targeted therapeutics and LHRH analogs are worthy of further exploration in UM.
背景
尽管葡萄膜黑色素瘤（UM）在男性中的发病率较高且预后较差，但仍有许多关于侵袭性UM妊娠患者的病例报告。这促使研究人员探索性激素和妊娠对UM发生发展的影响，并将激素作为潜在的治疗靶点。
总结
进行了一项系统的文献综述。需要更多的研究来阐明UM发病率和生存率性别差异的基础。对年轻UM患者进行种系突变评估将是有益的。重要的是，多项研究报告显示，非妊娠UM女性和妊娠UM女性的5年生存率和5年无转移生存率之间没有显著差异。多项病例对照研究对于产次如何影响UM风险存在分歧。然而，大多数研究一致认为口服避孕药和激素替代疗法对UM的发病率没有影响。讨论了目前针对妊娠UM患者的治疗策略。展望未来，本综述报告了基于雌激素受体（ER）、雌激素相关受体α（ERRα）和促黄体生成素释放激素（LHRH）受体在UM中表达证据的靶向受体化疗的最新研究。
关键信息
基于文献综述，UM并非口服避孕药、激素替代疗法或妊娠的禁忌证。保留眼球放疗可作为妊娠患者的一种治疗选择。由于在一部分未经选择的UM中存在ER，应探索其与他莫昔芬等药物辅助靶向治疗的潜力。应借鉴皮肤黑色素瘤中雌激素受体组织比例（ERα:ERβ）的经验来评估其治疗预测价值。此外，针对ERRα的治疗药物和LHRH类似物在UM中值得进一步探索。
Zotero 插件