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Muskelinvasives Harnblasenkarzinom nach radikaler Zystektomie

Prognosefaktoren der adjuvanten Chemotherapie

Muscle invasive bladder cancer after radical cystectomy

Prognostic factors of adjuvant chemotherapy

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Zusammenfassung

Hintergrund

Die Indikation zur Einleitung einer adjuvanten Chemotherapie beim Urothelkarzinom der Harnblase nach radikaler Zystektomie wird entsprechend der verschiedenen internationalen Leitlinien aufgrund der suboptimalen Evidenz zunehmend kritisch beurteilt. Die adjuvante Therapie sollte aufgrund der ungünstigen Evidenzsituation vornehmlich klinischen Studien vorbehalten werden. Unter klinischen Bedingungen könnte die adjuvante Chemotherapie bei Patienten mit ausgedehnten lymphknotenpositiven Befunden eingesetzt werden. Klinische, pathohistologische und molekulare Risikofaktoren, die mit einem günstigen bzw. ungünstigen Ansprechen auf die adjuvante Therapie verbunden sind, werden in der Literatur nur spärlich beschrieben.

Ergebnisse

Der Nachweis einer Hämangiosis und/oder Lymphangiosis carcinomatosa sowie einer extranodalen Extension bei Vorliegen von Lymphknotenmetastasen scheint mit einem ungünstigen Ansprechen assoziiert zu sein. Unter den molekularen Biomarkern scheint aufgrund der Studienlage den Markern ERCC-1, XAF-1 sowie den antiapoptotischen Proteinen der Bcl-2-Familie eine mögliche Rolle in der Resistenzentwicklung und damit einem ungünstigen Ansprechen auf die systemische adjuvante Chemotherapie zuzukommen. Hier sind für die Zukunft klinikübergreifende klinische und basiswissenschaftliche Untersuchungen zu fordern.

Abstract

Background

The indications to administer adjuvant systemic chemotherapy to patients with urothelial carcinoma of the bladder who underwent radical cystectomy is discussed controversially and all international guidelines are very restrictive with regard to its recommendation for routine daily practice due to the low scientific evidence concerning its therapeutic benefit. Currently, adjuvant systemic chemotherapy should be preferably administered within clinical trials. In the daily routine adjuvant treatment might be given in patients with lymph node positive disease. Clinical, pathohistological and molecular biomarkers which might be associated with a positive or negative treatment response have been evaluated sparsely in the past.

Results

The presence of hemangiosis/lymphangiosis carcinomatosa and/or extranodal expansion in patients with lymph node metastases appears to be associated with a poor outcome. The markers ERCC-1, XAF and anti-apoptotic proteins of the Bcl-2 family seem to represent the most promising biomarkers associated with response to adjuvant cisplatin-based chemotherapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A.K. Thissen, D. Pfister und Axel Heidenreich geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Urologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    A.K. Thissen, D. Pfister &  A. Heidenreich

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  1. A.K. Thissen
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  2. D. Pfister
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Correspondence to A. Heidenreich.

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Thissen, A., Pfister, D. & Heidenreich, A. Muskelinvasives Harnblasenkarzinom nach radikaler Zystektomie. Urologe 52, 1233–1241 (2013). https://doi.org/10.1007/s00120-013-3311-5

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