Zusammenfassung
Zur Evaluierung von serologischen Verlaufsparametern der fernmetastasierten Melanom-Erkrankung
wurden drei prospektive Studien durchgeführt. Die Ergebnisse der Staging-Untersuchungen
wurden als unabhängiger Referenz-Standard zur Diagnose einer Erkrankungs-Progredienz
verwandt, und Interleukin-6 (Il-6), sein Surrogat C-reaktives Protein (CRP) und der
konventionelle Parameter Laktatdehydrogenase (LDH) wurden zum Zeitpunkt der Staging-Untersuchungen
im Serum bestimmt. Zum Vergleich wurden die Melanom-Marker S100β und „melanoma inhibitory
activity” (MIA) in den Seren gemessen. Die Patienten mit Progredienz der Metastasierung
wiesen statistisch signifikant höhere Konzentrationen der Serumparameter als die Patienten
mit Therapieansprechen auf, wenn beide Gruppen durch Medianwerte verglichen wurden.
Mit der Fläche unter den „Receiver Operating Characteristic” (ROC)-Kurven zeigten
sich sowohl Il-6, sein Surrogat CRP und die LDH als auch S100β und MIA geeignet, eine
Progression der Metastasierung tendenziell zu erkennen. In der multiplen logistischen
Regressions-Analyse resultierte die LDH als relevanter Faktor. Aufgrund ihrer hohen
Korrelationen mit der LDH konnten S100β und MIA die Information der LDH nur geringfügig
verbessern. Unter Anwendung von „classification and regression trees” (CART) erwies
sich das CRP mit einem Grenzwert von 0,5 mg/dl als der am meisten relevante Parameter.
Abstract
Monitoring melanoma patients suffering from distant metastases (American Joint Committee
on Cancer stage IV), we evaluated serum markers for the ability to discriminate progressive
from non-progressive disease. In three prospective studies, results of staging examinations
were used as independent reference standard for diagnosing progressive disease, and
interleukin-6 (Il-6), its surrogate C-reactive protein (CRP) and the conventional
parameter lactate dehydrogenase (LDH) were determined in serum just before. For comparison,
the melanoma markers S100β and melanoma inhibitory activity (MIA) were measured in
the sera. We found all tested serum parameters to be significantly elevated in progressive
disease by median values. Calculating the areas under the Receiver Operating Characteristic
(ROC) curves, Il-6, its surrogate CRP and LDH as well as S100β and MIA were useful
in diagnosing progressive disease. By multiple logistic regression analysis, LDH resulted
as relevant factor. S100β and MIA did not provide additional significant information
as they highly correlated with LDH with respect to clinical outcome. Applying classification
and regression trees (CART), we found CRP with a cut off value of 0.5 mg/dl to be
the most relevant serum marker.
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Dr. med. habil. M. Deichmann
Universitäts-Hautklinik Heidelberg
Voßstraße 2 · 69115 Heidelberg ·
Email: martin_deichmann@med.uni-heidelberg.de
