Lösliche Serumfaktoren als prognostische Marker des Melanoms: sHLA, sFas und IL-8

Zusammenfassung

Eine größere Anzahl serologischer Faktoren konnte in den letzten Jahren als Tumormarker des malignen Melanoms identifiziert werden. Für einen Großteil dieser Markerproteine konnte eine Korrelation mit der Prognose der Patienten gezeigt werden. Trotzdem gibt es aktuell keine internationalen Empfehlungen hinsichtlich eines routinemäßigen Einsatzes eines dieser Markerproteine. Der aktuell am häufigsten eingesetzte Marker ist das S100-β Protein, das ursprünglich als saures, Kalzium-bindendes Protein aus Rinderhirnextrakt dargestellt wurde. S100-β zeigte sich als nützlicher prognostischer Serummarker bei Patienten mit Melanom im metastasierten Stadium und stellt einen guten Verlaufsparameter für das Monitoring metastasierter Melanompatienten unter Chemotherapie dar. Andere Serumproteine, wie z. B. Melanoma Inhibiting Activity (MIA), wurden ebenfalls in zahlreichen Studien als serologische Prognoseindikatoren des Melanoms evaluiert, konnten jedoch die Aussagekraft des S100-β nicht übertreffen. Ein bedeutender Nachteil des S100-β ist dessen geringer prädiktiver Wert hinsichtlich der Prognose bei Patienten in frühen Erkrankungsstadien, vor Nachweis einer Metastasierung. Diese Patienten werden nach Exzision des Primärtumors aufwändigen Nachsorge-Untersuchungsprogrammen unterzogen, um eine eventuell auftretende Metastasierung möglichst frühzeitig zu erkennen und zu behandeln. Hierzu müssen diese Patienten aktuell invasive und kostenintensive Maßnahmen, wie beispielsweise die Exstirpation des Sentinel Lymphknotens, in Kauf nehmen. Insbesondere diese Patientengruppe würde von der Entwicklung neuer sensitiver und hinreichend genauer prognostischer Marker, die wenig aufwändig aus dem Serum des Patienten bestimmt werden könnten, profitieren.

Abstract

A variety of serological markers have been identified in malignant melanoma, most of them associated with disease progression. Nevertheless, none of them is currently recommended for routine diagnostic use by international guidelines. S100-β, originally described as an acidic, calcium-binding protein derived from a bovine brain extract, has been demonstrated as an appropriate serum marker in metastatic melanoma patients with high serum levels indicating disease progression or recurrence. Moreover, S100-β has been proved as a useful serum parameter in the monitoring of metastatic melanoma patients during ongoing chemotherapy. Other serological marker proteins like e. g. melanoma inhibiting activity (MIA) have been evaluated in several studies, but could not be approved to exceed the predictive value of S100-β. A major disadvantage of S100-β is the poor predictive value of this marker in early-stage non-metastasized melanoma patients. After surgical removal of their primary tumors, these patients are enrolled into elaborated follow-up examination programs aiming at a detection of recurrence of the disease as early as possible. To estimate their risk of recurrence, these patients currently have to undergo invasive and costly procedures like e. g. sentinel lymph node dissection. Therefore, the identification of sensitive and reliable serological markers with strong predictive impact for the patients' prognosis would be of high beneficial value for this group of patients.

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