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Chirurgische Optionen bei „cancer of unknown primary“ (CUP)

Surgical options in cancer of unknown primary (CUP)

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Zusammenfassung

Hintergrund

„Cancer of unknown primary“ (CUP) stellt eine im klinischen Alltag häufig auftretende heterogene Gruppe an Tumorerkrankungen dar, die bisher mit einer äußerst schlechten Prognose für die betroffenen Patienten einhergeht. Aufgrund der zunehmend besseren diagnostischen Möglichkeiten lassen sich Subgruppen von Patienten mit unterschiedlicher klinischer Prognose identifizieren. Neue, an die identifizierten Subgruppen angepasste Therapien, spielen zunehmend eine entscheidende Rolle.

Zielsetzung

In diesem Review sollen die Rolle der Chirurgie und die chirurgischen Optionen in der Therapie von CUP-Patienten erläutert werden.

Ergebnisse

Für die Therapie des CUP ist eine Eingruppierung der Patienten in unterschiedliche Subgruppen von Bedeutung, um die Patienten mit einer guten Prognose identifizieren zu können. Eine chirurgische Resektion der CUP-Metastasen stellt für 1) Frauen mit papillärer Peritonealkarzinose, 2) Frauen mit axillären Lymphknotenmetastasen eines Adenokarzinoms, 3) Patienten mit zervikalen Lymphknotenmetastasen eines Plattenepithelkarzinoms, 4) Patienten mit inguinalen Lymphknotenmetastasen, 5) Patienten mit mediastinalen/retroperitonealen Metastasen entlang der Mittellinie (extragonadale Keimzelltumoren) und für 6) Patienten mit lokalisierten, resezierbaren Metastasen eine lebensverlängernde Therapieoption dar.

Schlussfolgerung

Zusammen mit einer dem vermutlichen Primärtumor angepassten multimodalen Therapie stellt die Resektion von Metastasen bei verschiedenen Subgruppen des CUP eine wichtige Therapieoption dar.

Abstract

Background

Cancer of unknown primary site (CUP) comprises a relatively frequently occurring group of heterogeneous malignant tumors in the clinical routine, which currently has an abysmal prognosis for affected patients. Based on the improved diagnostic tools it is now possible to identify subgroups of patients with different clinical prognoses. New therapies adapted to these identified subgroups are becoming increasingly more relevant.

Aim

This review aims to evaluate the role of surgery and different surgical options in the therapy of patients with CUP.

Results

For the treatment of patients with CUP it is important to identify subgroups of patients with a better prognosis. Surgical resection of CUP metastasis is a therapy option leading to a prolonged survival in (1) women with papillary peritoneal adenocarcinomatosis, (2) women with axillary lymph node metastasis of adenocarcinoma, (3) patients with cervical lymph node metastasis of squamous cell carcinoma, (4) patients with inguinal lymph node metastasis, (5) patients with poorly differentiated carcinomas with midline distribution (e.g. extragonadal germ cell syndrome) and (6) patients with small resectable tumors.

Conclusion

Surgery is an important therapy option in different subgroups of patients with CUP. Together with multimodal therapy, adjusted according to the identified most likely origin of the primary tumor, it is possible to prolong patient survival.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Ulrich und T. Schmidt geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland

    T. Schmidt &  A. Ulrich

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  1. T. Schmidt
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  2. A. Ulrich
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Correspondence to A. Ulrich.

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Schmidt, T., Ulrich, A. Chirurgische Optionen bei „cancer of unknown primary“ (CUP). Radiologe 54, 140–144 (2014). https://doi.org/10.1007/s00117-013-2549-7

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