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Molekulares Lymphknotenstaging beim Prostata- und Harnblasenkarzinom

Molecular lymph node staging in prostate and bladder cancer

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Zusammenfassung

Ein histopathologisch positiver Lymphknotenstatus stellt einen wesentlichen Prognosefaktor für Tumorrezidiv und Mortalität nach radikaler Prostatektomie bei Patienten mit Prostatakarzinom bzw. nach radikaler Zystektomie bei Patienten mit Harnblasenkarzinom dar. Dennoch zeigt ein nicht geringer Teil der Patienten, deren Lymphknoten histopathologisch als tumorfrei beurteilt wurden, ein Tumorrezidiv innerhalb weniger Jahre. Als Ursache für ein Rezidiv bei Patienten mit negativem Lymphknotenstatus wird eine zum Operationszeitpunkt bereits vorhandene, aber mit den in der Routine verwendeten Methoden weder klinisch noch histopathologisch nachweisbare hämatogene oder lymphogene Metastasierung vermutet. Der molekulare Nachweis von Lymphknotenmetastasen ist ein vielversprechender Ansatz für eine sensitivere Diagnostik und eine bessere Risikostratifizierung jener Patienten, die einen histopathologisch negativen Lymphknotenstatus aufweisen.

Abstract

A positive lymph node status is a major prognostic factor for tumor recurrence and mortality following radical prostatectomy in prostate cancer patients or radical cystectomy in bladder cancer patients. However, despite having histopathologic negative lymph nodes, a substantial proportion of patient suffers from tumor recurrence within a few years after the operation. Tumor recurrence in node-negative patients may result from hematogeneous or lymphatic metastatic spread which remains undetected by standard clinical or histopathologic examinations. Molecular lymph node analysis is a potential method for detection of lymph node metastases with higher sensitivity and for prognostic risk stratification of patients with histopathologic negative lymph nodes.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Matthias M. Heck, Margitta Retz und Roman Nawroth geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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  1. Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    M.M. Heck, M. Retz & R. Nawroth

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  1. M.M. Heck
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  2. M. Retz
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  3. R. Nawroth
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Correspondence to M.M. Heck.

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Heck, M., Retz, M. & Nawroth, R. Molekulares Lymphknotenstaging beim Prostata- und Harnblasenkarzinom. Urologe 53, 484–490 (2014). https://doi.org/10.1007/s00120-014-3441-4

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  • DOI: https://doi.org/10.1007/s00120-014-3441-4

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