Zusammenfassung
Hintergrund
Die Nachsorge des nicht-muskelinvasiven Harnblasenkarzinoms (NMIBC) stellt eine nicht abschließend gelöste Herausforderung an den Urologen dar. Dabei muss sich die Intensität der Nachsorge am Rezidiv- bzw. Progressionsverhalten des Tumors einerseits und der individuellen Situation des Patienten andererseits orientieren.
Material und Methoden
Der nachfolgende Artikel beschäftigt sich mit der aktuellen Datenlage, der gültigen S3-Leitlinie und den verfügbaren Instrumenten zur Detektion von Rezidiven und Progression unter Berücksichtigung von Tumorstadien und Malignitätsgrad.
Ergebnisse
Grundsätzlich werden Urethrozystoskopie, Bildgebung und die Urinzytologie empfohlen, allerdings erscheinen die Empfehlungen bei sog. intermediärem Risikoprofil zu weitgehend. Situationsbedingt könnten Urinmarker die Nachsorge optimieren, wobei Ergebnisse aus prospektiv-randomisierten Studien bislang ausstehen.
Schlussfolgerung
Die aktuelle Nachsorge des NMIBC ist invasiv, mit dem Risiko von Nebenwirkungen behaftet und kostentreibend. Angesichts fehlender wissenschaftlicher Evidenz beruhen Empfehlungen zur Nachsorge des NMIBC naturgemäß auf Expertenmeinung. Insbesondere bei Patienten mit intermediärem Risikoprofil erfolgt nach Ansicht der Autoren derzeit eine Überdiagnostik. Erste prospektive, markerbasierte Studien laufen und werden zeitnah hilfreich sein, die Datenlage in diesem für die urologische Praxis relevanten Sektor zu verbessern.
Abstract
Background
Follow-up for non-muscle invasive bladder cancer (NMIBC) is a challenge for urologists that has not been finally resolved. The intensity of follow-up is based on the recurrence and progression behavior of the tumor as well as the patient’s individual situation.
Materials and methods
The following article focuses on the current data situation, the valid German S3 guideline and the available instruments for the detection of relapses and progression, taking into account tumor stages and degree of malignancy.
Results
Urethrocystoscopy, imaging and urine cytology are generally recommended, but the recommendations appear to be too extensive in the case of so-called intermediate risk profiles. Depending on the situation, urine markers could optimize follow-up, although results from prospective randomized studies are still pending.
Conclusions
The current follow-up of NMIBC is invasive, carries the risk of side effects and increases costs. In the absence of scientific evidence, recommendations for follow-up for NMIBC are naturally based on expert opinion. In the opinion of the authors, overdiagnosis is currently taking place particularly in patients with an intermediate risk profile. The first prospective, marker-based studies are ongoing and will be helpful in the near future to improve the data situation relevant to urological practice.
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N. von Landenberg: Literature search, manuscript drafting; B. J. Schmitz-Dräger: Concept, literature search, manuscript drafting; E. Bismarck: Literature search, manuscript drafting; K. Kernig: Manuscript drafting; E. Erne: Manuscript drafting; P.J. Goebell: Manuscript drafting; N. Benderska-Söder: Literature search, manuscript drafting
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N. von Landenberg, N. Benderska-Söder, E. Bismarck, K. Kernig, E. Erne, P.J. Goebell und B. J. Schmitz-Dräger geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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von Landenberg, N., Benderska-Söder, N., Bismarck, E. et al. Rationale Nachsorge des nicht-muskelinvasiven Harnblasenkarzinoms. Urologe 60, 1409–1415 (2021). https://doi.org/10.1007/s00120-021-01683-6
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DOI: https://doi.org/10.1007/s00120-021-01683-6