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Das nicht-muskelinvasive High-grade-Harnblasenkarzinom

Non-muscle-invasive high-grade bladder cancer

  • Leitthema
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Zusammenfassung

Hintergrund

Das nicht-muskelinvasive Harnblasenkarzinom (NMIBC) mit einem geringen Differenzierungsgrad stellt eine besondere Herausforderung dar.

Methode

Während nach wie vor die Harnzytologie der verlässlichste und effektivste harnbasierte Marker ist und es keine wesentlichen Neuerungen auf diesem Gebiet gibt, hat die photodynamische Diagnostik ihren wohl deutlichsten Stellenwert in der transurethralen Resektion der Harnblase (TUR-B) von T1-High-grade-Tumoren und es deuten sich neue Techniken wie die Hybrid-knife-TUR-B an. Die histopathologische Beurteilung von pT1-Tumoren kann um die Beschreibung der exakten Eindringtiefe, des sog. Substagings und des Invasionsmusters, ergänzt werden.

Ergebnisse

Eine intravesikale Therapie mit Bacillus Calmette-Guérin (BCG) stellt als Goldstandard eine Säule der blasenerhaltenden Therapie dar und sollte als Erhaltungstherapie über zumindest ein Jahr konzipiert sein. Bei entsprechender Risikokonstellation ist eine Zystektomie ein sicheres und bewährtes Konzept bei einem High-grade-Harnblasenkarzinom — auch ohne den Nachweis einer Muskelinvasion.

Abstract

Background

Non-muscle-invasive bladder cancer with a low-grade differentiation represents a special challenge.

Method

Although urine cytology is still the most reliable and effective urine-based marker and there are no substantial novel aspects in this field, photodynamic diagnostics have the most important value in transurethral resection of the bladder (TURB) of high-grade T1 tumors and new techniques, such as hybrid knife TURB are coming up. The histopathological assessment of T1 tumors can be supplemented by a description of the exact penetration depth, so-called substaging and the invasion pattern.

Results

Intravesicle therapy with Bacillus Calmette-Guèrin (BCG) represents the gold standard and a pillar of bladder-preserving therapy and should be planned as maintenance therapy for at least 1 year. With the right risk constellation cystectomy is a safe and proven concept for high-grade bladder cancer, even without proof of muscle invasion.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Gakis, A. Stenzl, T. Horn, J.E. Gschwend, W. Otto und M. Burger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland

    G. Gakis & A. Stenzl

  2. Urologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    T. Horn & J.E. Gschwend

  3. Klinik und Poliklinik für Urologie, Universität Regensburg am Caritas-Krankenhaus St. Josef Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland

    W. Otto &  M. Burger

Authors
  1. G. Gakis
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  2. A. Stenzl
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  3. T. Horn
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  4. J.E. Gschwend
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  5. W. Otto
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  6. M. Burger
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Correspondence to M. Burger.

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Gakis, G., Stenzl, A., Horn, T. et al. Das nicht-muskelinvasive High-grade-Harnblasenkarzinom. Urologe 54, 491–498 (2015). https://doi.org/10.1007/s00120-015-3774-7

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  • DOI: https://doi.org/10.1007/s00120-015-3774-7

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