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Aktuelle klinischpathologische Klassifikation von Karzinomen des Analkanales

Actual clinico-pathological classification of carcinomas of the anal canal

  • Themenschwerpunkt: „Analkarzinom“
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Zusammenfassung

Grundlagen: Eine exakte Tumorklassifikation ist sowohl für die Wahl des Behandlungsverfahrens im Rahmen einer modernen multimodalen Therapie von Karzinomen des Analkanals als auch für die Schätzung der Prognose und der Analyse von Therapieergebnissen wesentlich. Voraussetzung dafür ist eine exakte Unterscheidung der Karzinome des Analkanals von solchen des Rektums einerseits und Karzinomen des Analrandes andererseits.

Methodik: Die aktuelle klinisch-pathologische Klassifikation von Karzinomen des Analkanals wird anhand einer Literaturübersicht besprochen. Sie basiert im Wesentlichen auf dem histopathologischen Tumortyping und Grading der WHO sowie dem Tumorstaging nach dem TNM-System und der Residualtumor-Klassifikation (R-Klassifikation) der UICC.

Ergebnisse: Dem histopathologischen Typing nach WHO kommt vielfach eine therapeutische Weichenstellung zu, da Plattenepithelkarzinome verschiedener Subtypen heute vor allem mit simultaner Radiochemotherapie, die verschiedenen Adenokarzinomtypen hingegen vorzugsweise mit radikaler chirurgischer Resektion behandelt werden. Durch das histopathologische Grading von WHO und UICC können die prognostisch günstigeren Karzinome mit niedrigem Malignitätsgrad von solchen mit hohem Malignitätsgrad ungünstigerer Prognose unterschieden werden. Die anatomische Ausbreitung des Tumors wird durch die TNM/pTNM-Klassifikation und die darauf beruhende Stadiengruppierung der UICC beurteilt. Sie dient in Kombination mit der R-Klassifikation der Schätzung der Prognose. Weitere selbständige Prognosefaktoren sind der prätherapeutische SCCAg-Serumspiegel und wahrscheinlich auch der Ploidiestatus.

Schlußfolgerungen: Eine enge, klinisch-pathologische Kooperation ist die unabdingbare Voraussetzung für eine histologieund stadiengerechte moderne Tumorbehandlung von Karzinomen des Analkanals im Rahmen multimodaler Therapiekonzepte.

Summary

Background: The careful classification of carcinomas of the anal canal is required for planning of treatment including the modern multimodal concepts as well as for estimation of prognosis and analysis of treatment results. An exact discrimination of carcinomas of the anal canal from those of the rectum as well as from tumors of the anal margin represents a precondition for tumor classification.

Methods: The actual clinico-pathological classification of carcinomas of the anal canal is discussed by reviewing the literature. It is based on histopathological tumor typing and grading of the WHO as well as on the tumorstaging according to the TNM-system and the R-(residual tumor)-classification of the UICC.

Results: The histopathological tumor typing according to the WHO is a guideline for the choice of therapeutic procedures because squamous cell carcinomas of different subtypes are nowadays usually treated by simultaneous radiochemotherapy, whereas adenocarcinomas predominantly undergo primary surgical resection. On the basis of histopathological grading according to the WHO and UICC carcinomas of low grade malignancy with better prognosis can be discriminated from those of high grade malignancy with usually worse prognosis. The anatomical spread of tumor is classified according to TNM/pTNM and stage grouping of the UICC. Together with the R-classification staging enables the estimation of prognosis. Further independent prognostic factors are the pretherapeutic SCCAg serum level and probably ploidy status.

Conclusions: A close cooperation between clinicians and pathologists is an essential precondition for the present histology and stage adapted multimodal treatment of carcinomas of the anal canal.

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Authors and Affiliations

  1. Institut für Pathologie der Universität Graz, Auenbruggerplatz 25, A-8036, Graz

    M. Klimpfinger

  2. Chirurgischen Universitätsklinik Graz, Österreich

    H. Hauser & A. Berger

  3. Chirurgischen Universitätsklinik Erlangen-Nürnberg, Erlangen, Deutschland

    P. Hermanek

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Klimpfinger, M., Hauser, H., Berger, A. et al. Aktuelle klinischpathologische Klassifikation von Karzinomen des Analkanales. Acta Chir Austriaca 26, 345–351 (1994). https://doi.org/10.1007/BF02620033

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