OPRM1 receptor as new biomarker to help the prediction of post mastectomy pain and recurrence in breast cancer.
OPRM1 receptor as new biomarker to help the prediction of post mastectomy pain and recurrence in breast cancer.
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OPRM1 受体作为新的生物标志物，有助于预测乳房切除术后疼痛和乳腺癌复发。
作者：
M. Gregori;L. Diatchenko;I. Belfer;M. Allegri
乳腺癌是全世界女性中最常见的癌症类型。术后短期恢复是复杂的许多因素，包括炎症和免疫反应失衡，急性疼痛与功能障碍相关，以及慢性乳腺癌术后疼痛(CPMP)，约有25%-60%的患者发生这种情况。阿片类药物是最常见的治疗癌症疼痛的药物，具有免疫抑制作用，因此，它们可能直接和/或间接影响癌症的长期复发。此外，它们还会产生内分泌疾病，主要表现为下丘脑-垂体-性腺轴或下丘脑-垂体-肾上腺轴功能障碍。CPMP和阿片类药物反应的个体间差异被认为在很大程度上是由于调节阿片类药物药效的μ-阿片受体(OPRM1)基因位点的遗传差异。因此，OPRM1基因可能在乳腺癌术后短期疗效和长期随访中发挥关键作用，成为阿片类药物治疗的慢性乳腺癌术后疼痛患者乳腺癌复发的新生物标志物。因此，OPRM1可能在不久的将来被用于定制阿片类药物的治疗，不仅避免阿片类药物的副作用，而且还可以避免疾病的进展。在这篇综述中，我们评估了关于这一主题的文献现状，以及获得最安全的个体化乳腺癌术后止痛治疗的可能步骤。因此，个性化的疼痛治疗策略对于控制疼痛和控制癌症的进展可能是有用的。
Breast cancer is the most common type of cancer among women worldwide. Short-term postsurgical recovery is complicated by many factors, including imbalanced inflammatory and immune response, acute pain associated with functional impairment, and chronic postmastectomy pain (CPMP), developed by about 25-60% of patients. Opioids, most common drugs used for treatment of cancer pain, are immunosuppressive, and therefore, they might directly and/or indirectly influence long-term cancer recurrence. Moreover, they also produce endocrinopathy, which consists primarily of hypothalamic-pituitary-gonadal axis or hypothalamic-pituitary-adrenal axis dysfunction. The interindividual variability in both CPMP and opioid response is believed to be largely underlined by genetic variability in the gene locus for μ-opioid receptor (OPRM1) that modulates opioid pharmacodynamics. For this reason, OPRM1 genotype may play a key role both in short-term postmastectomy outcome and in long-term follow-up, becoming a new biomarker for breast cancer recurrence in patients suffering from chronic postmastectomy pain managed by opioid therapy. Hence OPRM1 might be used in near future to customize the opioid therapy, avoiding not only opioid side effects but also the disease progression. In this review we evaluate the literature state of the art on this topic and possible steps towards obtaining the safest individualized postmastectomy analgesic therapy. Therefore, a personalized pain treatment strategy might be useful to both manage pain and control cancer disease progression.