Zusammenfassung
Das Nierenzellkarzinom ist ein vom Nierenparenchym ausgehender maligner Tumor, der ca. 2–3 % aller bösartigen Erkrankungen des Erwachsenen ausmacht. Es ist im Frühstadium symptomarm bzw. symptomlos. Aufgrund des breiten Einsatzes bildgebender Verfahren werden derzeit mehr als 50 % aller Nierenzellkarzinome zufällig und diese somit meist in frühen Stadien entdeckt. Neben einer sorgfältigen Anamnese und körperlichen Untersuchung sollten eine Laboruntersuchung des Blutes sowie eine Urinuntersuchung erfolgen. Meist wird an bildgebenden Verfahren zunächst eine Ultraschalluntersuchung des Abdomens und der Nieren durchgeführt, später auch CT und MRT. Die Einteilung erfolgt nach dem TNM-System. Die operative Entfernung des Tumors stellt die einzige kurative Option bei der Behandlung des Nierenzellkarzinoms dar. Das Nierenzellkarzinom ist ein wenig strahlenempfindlicher Tumor und eine primäre Strahlentherapie spielt beim Nierenzellkarzinom somit keine essenzielle Rolle. In den letzten Jahren hat sich die Therapie des metastasierten Nierenzellkarzinoms aufgrund der Zulassung zahlreicher neuer Substanzen (Multikinaseinhibitoren, selektive Angiogenesehemmer, mTOR-Inhibitoren), die oftmals zu einer deutlichen Verlängerung des progressionsfreien Überlebens führen, stark gewandelt. Die relative 5-Jahres-Überlebensrate liegt in Deutschland zwischen 65 und 75 %, diese ist abhängig vom Stadium bei Erstdiagnose und dem histologischen Subtyp.
Similar content being viewed by others
Literatur
Aapro M, Abrahamsson PA, Body JJ, Coleman RE, Colomer R, Costa L et al (2008) Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol 19(3):420–432
Blom JH, Van PH, Marechal JM, Jacqmin D, Schroder FH, De Prijck L et al (2009) Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 30881. Eur Urol 55(1):28–34
Brahmer JR, Tykodi SS, Chow LQ, Hwu WJ, Topalian SL, Hwu P et al (2012) Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med 366(26):2455–2465
Cho E, Adami HO, Lindblad P (2011) Epidemiology of renal cell cancer. Hematol Oncol Clin North Am 25(4):651–665
Cohen HT, McGovern FJ (2005) Renal-cell carcinoma. N Engl J Med 353(23):2477–2490
Diamond JR, Salgia R, Varella-Garcia M, Kanteti R, LoRusso PM, Clark JW et al (2013) Initial clinical sensitivity and acquired resistance to MET inhibition in MET-mutated papillary renal cell carcinoma. J Clin Oncol 31(16):e254–e258
Eisen T, Joensuu H, Nathan PD, Harper PG, Wojtukiewicz MZ, Nicholson S et al (2012) Regorafenib for patients with previously untreated metastatic or unresectable renal-cell carcinoma: a single-group phase 2 trial. Lancet Oncol 13(10):1055–1062
Escudier B, Pluzanska A, Koralewski P, Ravaud A, Bracarda S, Szczylik C et al (2007a) Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet 370(9605):2103–2111
Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M et al (2007b) Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 356(2):125–134
Escudier B, Albiges L, Sonpavde G (2013) Optimal management of metastatic renal cell carcinoma: current status. Drugs 73(5):427–438
Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van PH, Crawford ED (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171(3):1071–1076
Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27(34):5794–5799
Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A et al (2007) Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 356(22):2271–2281
Iacovelli R, Carteni G, Sternberg CN, Milella M, Santoni M, Di Lorenzo G et al (2013) Clinical outcomes in patients receiving three lines of targeted therapy for metastatic renal cell carcinoma: results from a large patient cohort. Eur J Cancer 49:2134–2142
Kroeger N, Choueiri TK, Lee JL, Bjarnason GA, Knox JJ, MacKenzie MJ, Wood L, Srinivas S, Vaishamayan UN, Rha SY, Pal SK, Yuasa T, Donskov F, Agarwal N, Tan MH, Bamias A, Kollmannsberger CK, North SA, Rini BI, Heng DY (2014) Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy. Eur Urol. Jun; 65(6):1086–1092. doi: 10.1016/j.eururo.2013.07.031. Epub 2013 Jul 30
Leibovich BC, Blute ML, Cheville JC, Lohse CM, Frank I, Kwon ED et al (2003) Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer 97(7):1663–1671
Linehan WM, Pinto PA, Bratslavsky G, Pfaffenroth E, Merino M, Vocke CD et al (2009) Hereditary kidney cancer: unique opportunity for disease-based therapy. Cancer 115(10 Suppl):2252–2261
Lipton A, Zheng M, Seaman J (2003) Zoledronic acid delays the onset of skeletal-related events and progression of skeletal disease in patients with advanced renal cell carcinoma. Cancer 98(5):962–969
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406
Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M (2002) Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 20(1):289–296
Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356(2):115–124
Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S et al (2008) Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 372(9637):449–456
Motzer RJ, Hutson TE, Cella D, Reeves J, Hawkins R, Guo J et al (2013a) Pazopanib versus sunitinib in metastatic renal-cell carcinoma. N Engl J Med 369(8):722–731
Motzer RJ, Nosov D, Eisen T, Bondarenko I, Lesovoy V, Lipatov O et al (2013b) Tivozanib versus sorafenib as initial targeted therapy for patients with metastatic renal cell carcinoma: results from a phase III trial. J Clin Oncol 31(30):3791–3799
Motzer RJ, Escudier B, Tomczak P, Hutson TE, Michaelson MD, Negrier S et al (2013c) Axitinib versus sorafenib as second-line treatment for advanced renal cell carcinoma: overall survival analysis and updated results from a randomised phase 3 trial. Lancet Oncol 14(6):552–562
Nabi G, Cleves A, Shelley M (2010) Surgical management of localised renal cell carcinoma. Cochrane Database Syst Rev (3):CD006579
Patard JJ, Kim HL, Lam JS, Dorey FJ, Pantuck AJ, Zisman A et al (2004) Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study. J Clin Oncol 22(16):3316–3322
Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L, Ficarra V, Zisman A et al (2005) Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol 23(12):2763–2771
Rini BI, Campbell SC, Escudier B (2009) Renal cell carcinoma. Lancet 373(9669):1119–1132
Rini BI, Escudier B, Tomczak P, Kaprin A, Szczylik C, Hutson TE et al (2011) Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet 378(9807):1931–1939
Sternberg CN, Davis ID, Mardiak J, Szczylik C, Lee E, Wagstaff J et al (2010) Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 28(6):1061–1068
Topalian SL, Hodi FS, Brahmer JR, Gettinger SN, Smith DC, McDermott DF et al (2012) Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med 366(26):2443–2454
Weight CJ, Larson BT, Fergany AF, Gao T, Lane BR, Campbell SC et al (2010) Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 183(4):1317–1323
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag Berlin Heidelberg
About this entry
Cite this entry
Heine, A., Brossart, P. (2015). Nierenzellkarzinom. In: Lehnert, H., et al. DGIM Innere Medizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54676-1_511-1
Download citation
DOI: https://doi.org/10.1007/978-3-642-54676-1_511-1
Received:
Accepted:
Published:
Publisher Name: Springer, Berlin, Heidelberg
Online ISBN: 978-3-642-54676-1
eBook Packages: Springer Referenz Medizin