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Epidemiologie, Diagnostik und chirurgische Therapie des Nierenzellkarzinoms

Epidemiology, diagnosis, and surgical treatment of renal cell carcinoma

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Zusammenfassung

Epidemiologie

Nierenneoplasien machen etwa 3–4 % aller malignen Tumoren des Erwachsenen aus, und etwa 80–90 % aller malignen Tumoren der Niere sind Nierenzellkarzinome.

Diagnostik

Die Sonografie gilt als die führende Untersuchung zur Frühdetektion von Nierentumoren.

Therapie

In den letzten Jahren wurde die Therapie des Nierenzellkarzinoms durch neue therapeutische Möglichkeiten sowohl beim lokal begrenzten als auch in fortgeschrittenen und metastasierten Stadien bereichert. Die Klassifikation des Nierenzellkarzinoms erfolgt auf Grundlage der TNM- (T: Tumor, N: Lymphknotenbefall, M: Metastasen) und der UICC-Kriterien (UICC: „Union internationale contre le cancer“). Zum gegenwärtigen Zeitpunkt zählen sog. „targeted drugs“ wie Tyrosinkinaseinhibitoren, VEGF-Rezeptor-Antagonisten (VEGF: „vascular endothelial growth factor“) oder mTOR-Inhibitoren (mTOR: „mammalian target of rapamycin“) zum Standard der medikamentösen Therapie. Eine Verbesserung der Ansprechrate auf diese Behandlung mittels zytoreduktiver Tumornephrektomie oder Metastasenresektion ist anzunehmen und sollte insbesondere bei Patienten mit gutem Performance-Status erfolgen. Darüber hinaus kann die Metastasenchirurgie bei solitären oder komplett resektablen Befunden durchaus auch einen kurativen Behandlungsansatz darstellen.

Prognose

Bereits bei der Diagnosestellung liegt bei etwa 25–30 % aller Patienten mit einem Nierenzellkarzinom eine Metastasierung vor. Bei weiteren 20–30 % der Patienten, die sich einer radikalen Nephrektomie mit kompletter Tumorentfernung unterziehen, kommt es zu einem Progress. Das metastasierte Nierenzellkarzinom hat bei einer medianen Gesamtüberlebenszeit von etwa 2 Jahren eine insgesamt schlechte Prognose.

Abstract

Epidemiology

Renal tumors make up about 3–4 % of all malignant tumors of the adults, and approximately 80–90 % of all malignant tumors of the kidney are renal cell carcinomas.

Diagnosis

Sonography is the leading examination for early detection of kidney tumors.

Therapy

The treatment of renal cell carcinoma has been enriched in recent years by new therapeutic options for localized and metastatic cancer. The classification of renal cell carcinoma is based on TNM and UICC criteria. The current standard medicinal therapy includes the use of tyrosine kinase inhibitors, antiangiogenic substances, such as VEGF receptor antagonists (VEGF: vascular endothelial growth factor) or mTOR inhibitors (mTOR: mammalian target of rapamycin). Improvement in clinical response is to be expected when surgical tumor debulking by nephrectomy or metastasectomy is performed before systemic therapy is started and should be considered especially in patients with a good performance status. In addition, complete resection of solitary or at least a limited number of metastases can potentially be done with curative intent.

Prognosis

At the time of diagnosis, 25–30 % of all patients with renal cell carcinoma already present with metastatic disease. Furthermore, 20–30 % of patients with renal cell carcinoma will have progressive disease despite radical nephrectomy with complete tumor resection. Metastatic renal cell carcinoma has a poor prognosis with a median overall survival rate of approximately 2 years.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Kurosch, M. Reiter und A. Haferkamp geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    M. Kurosch, M. Reiter & A. Haferkamp

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  1. M. Kurosch
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  2. M. Reiter
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  3. A. Haferkamp
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Correspondence to M. Kurosch.

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Kurosch, M., Reiter, M. & Haferkamp, A. Epidemiologie, Diagnostik und chirurgische Therapie des Nierenzellkarzinoms. Onkologe 20, 899–910 (2014). https://doi.org/10.1007/s00761-014-2750-y

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