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Therapiekonzepte für histologische Varianten und nichturotheliale Histologie von Blasentumoren

Treatment concepts for histological variants and nonurothelial histology of bladder tumors

Zusammenfassung

Hintergrund

30 % der Blasentumoren weisen eine histologische Variante oder eine nichturotheliale Histologie auf. Die einzelnen Varianten sind selten, was das Design von Studien zu diesen Entitäten und den Entwurf von Therapiekonzepten erschwert. Die Diagnosehäufigkeit der histologischen Varianten nimmt zu.

Ziel der Arbeit

Darstellung der aktuellen Therapiekonzepte bei urothelialen Varianten und nichturothelialen Blasentumoren.

Material und Methoden

Nicht systematische PubMed-Suche mit den Stichwörtern „bladder cancer“, „variant histology“ sowie „non urothelial bladder cancer“ unter Berücksichtigung aktueller Guidelines der Fachgesellschaften EAU, ESMO und NCCN.

Ergebnisse

Bei plattenepithelialer oder glandulärer Differenzierung wird eine Therapie entsprechend dem konventionellen Urothelkarzinom empfohlen. Tumoren mit mikropapillärer, sarkomatoider und plasmazytoide Variante sowie reine Plattenepithel- und Adenokarzinome sollten mit radikaler Zystektomie und Lymphadenektomie sowohl im nichtmuskelinvasiven als auch im muskelinvasiven Stadium behandelt werden. Bei reinen Plattenepithelkarzinomen sollte im muskelinvasiven Stadium zusätzlich eine perioperative Radiotherapie erwogen werden. Kleinzellige neuroendokrine Tumoren im lokal begrenzten Stadium werden mit neoadjuvanter Chemotherapie, gefolgt von einer konsolidierenden Lokaltherapie behandelt.

Diskussion

Histologische Varianten des Urothelkarzinoms und nichturotheliale Blasentumoren sind häufig mit einer schlechteren Prognose verbunden. Die histopathologische Diagnosestellung ist herausfordernd, aber unverzichtbar für eine korrekte Therapieentscheidung. Etablierte Guidelines für die einzelnen Entitäten existieren meist nicht. Es müssen Anstrengungen unternommen werden zum Einschluss von solchen Patienten in randomisierten Studien.

Abstract

Background

Approximately 30% of bladder tumors show a histological variant or a nonurothelial histology. The individual variants are rare, which complicates the design of studies for these entities and the design of treatment concepts. The frequency of a diagnosis of histological variants is increasing.

Objective

Presentation of current treatment concepts for urothelial variants and nonurothelial bladder tumors.

Material and methods

Nonsystematic search in PubMed with the keywords bladder cancer, variant histology and nonurothelial bladder cancer, taking the current guidelines of the specialist societies EAU, ESMO and NCCN into account.

Results

Treatment of squamous cell or glandular differentiation follows the same pathways as recommended for conventional urothelial carcinoma. Micropapillary, sarcomatoid and plasmacytoid variants as well as pure squamous cell carcinoma and adenocarcinoma should be treated by radical cystectomy and lymphadenectomy in both non-muscle-invasive and muscle-invasive stages. In cases of a pure squamous cell carcinoma, perioperative radiotherapy should be considered in the muscle-invasive stage. Localized small cell neuroendocrine tumors are treated with neoadjuvant chemotherapy followed by a consolidating local treatment.

Conclusion

Histological variants of urothelial carcinoma and nonurothelial bladder tumors often have a poor prognosis. The histopathological diagnosis is challenging but indispensable for a correct treatment decision. Established treatment guidelines for the individual entities do not usually exist. Efforts must be made to include such patients in randomized trials.

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Correspondence to Katharina Hoppe.

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Interessenkonflikt

K. Hoppe weist auf folgende Beziehungen hin: Merck, Pfizer. R. Cathomas weist auf folgende Beziehungen hin: Consulting für Astellas, Astra Zeneca, Janssen, Merck, BMS, MSD, Roche, Pfizer, Ipsen, Bayer, Sanofi. Honoraria von Janssen, Astellas, BMS.

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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Hoppe, K., Cathomas, R. Therapiekonzepte für histologische Varianten und nichturotheliale Histologie von Blasentumoren. Onkologie 28, 799–804 (2022). https://doi.org/10.1007/s00761-022-01221-9

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Schlüsselwörter

  • Neoadjuvante Therapie
  • Neuroendokrine Tumoren
  • Plattenepithelkarzinom
  • Adenokarzinom
  • Lymphknotenexzision

Keywords

  • Neoadjuvant therapy
  • Neuroendocrine tumors
  • Carcinoma, squamous cell
  • Adenocarcinoma
  • Lymph node excision