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Das Urothelkarzinom des oberen Harntraktes

Ein Update über klinische und pathologische prognostische Faktoren

Upper tract urothelial carcinoma

An update on clinical and pathological prognostic factors

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Zusammenfassung

Das Urothelkarzinom des oberen Harntrakts (UTUC) ist eine seltene, aber potentiell tödliche Erkrankung. Eine akkurate Risikostratifizierung von UTUC-Patienten ist aufgrund eines schwierigen klinischen Stagings eine Herausforderung. Die Identifizierung von Risikofaktoren kann zu einer individualisierten Patientenberatung und Therapieentscheidung beitragen und somit den Erkrankungsverlauf beeinflussen.

Ein nicht-systematisches PubMed/Medline-Literaturreview wurde durchgeführt, um klinische und pathologische Risikofaktoren, sowie urinbasierte prädiktive Marker zu identifizieren. Obgleich in den vergangenen 5 Jahren zahlreiche Studien über mögliche Risikofaktoren beim UTUC publiziert worden sind, so ist die diesbezügliche Evidenz jedoch weiterhin limitiert. Derzeit liegen keine prospektiven, randomisierten Studienergebnisse vor, die eine ausreichende Evidenz bedingen würden. Die radikale Nephroureterektomie stellt die Standardtherapie des muskelinvasiven und Hochrisko-UTUC dar. Zahlreiche klinische und pathologische Faktoren (z. B. Tumorstadium und -grad, Alter, präoperative Hydronephrose, lymphovaskuläre Invasion, Tumornekrose und -architektur, Verzögerung zwischen Diagnose und endgültiger Therapie) sind mit dem Erkrankungsverlauf assoziiert. Die Urinzytologie und Urinanalyse mittels Fluoreszenz-in-situ-Hybridisierung stellen derzeit die gängigsten Urinmarker beim UTUC dar.

Prospektive randomisierte Studien werden dringend benötigt, um neue Risikofaktoren zu identifizieren und die Effizienz gegenwärtiger zu bestätigen. Die Verwendung identifizierbarer Risikofaktoren in multivariablen Vorhersagemodellen kann bei Therapieentscheidungen hinsichtlich Art der Operation, Durchführung einer Lymphadenektomie oder perioperativen Chemotherapie behilflich sein.

Abstract

Upper urinary tract urothelial carcinoma (UTUC) is an uncommon but potentially lethal disease. Accurate risk stratification remains a challenge owing to the difficulty of clinical staging. Identification of risk factors may lead to individualized treatment and patient counselling and holds the potential to improve outcome. A non-systematic PubMed/Medline literature research was performed to identify and summarize clinical and pathological risk factors and urine-based markers which are associated with clinical outcome.

Although knowledge of potential prognostic factors has improved over the last 5 years the overall evidence on UTUC risk factors remains limited and prospective, randomized trials are still missing. Radical nephroureterectomy is currently standard treatment for high-grade and muscle invasive UTUC. Several clinical and pathological factors (e.g. stage, grade, age, hydronephrosis, lymphovascular invasion, tumor necrosis and architecture, delay between diagnosis and surgery) were identified to be associated with outcome. Urinary cytology and fluorescence in-situ hybridization are the most commonly used urinary markers.

Prospective randomized controlled trials are urgently needed to identify new risk factors and assess the efficacy. The incorporation of such prognosticators into multivariable prediction models may help to guide decision-making with regard to type of treatment, performance of lymphadenectomy and consideration of neoadjuvant or adjuvant systemic therapy.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    M. Rink, M. Adam, J. Hansen, F.K. Chun, S.A. Ahyai, O. Engel, R. Heuer, C. Eichelberg, M. Fisch & R. Dahlem

  2. Weill Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, 10021, New York, USA

    M. Rink &  S.F. Shariat

  3. Landeskrankenhaus Weinviertel-Korneuburg, Korneuburg, Österreich

    M. Remzi

  4. Klinik für Urologie, Bereich für Translationale Prostatakarzinom Forschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    T. Schlomm

  5. Martini Klinik Prostatakarzinomzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    T. Schlomm

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  1. M. Rink
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  2. M. Adam
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  3. J. Hansen
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Dr. M. Rink und Dr. M. Adam waren zu gleichen Teilen an der Manuskripterstellung beteiligt.

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Rink, M., Adam, M., Hansen, J. et al. Das Urothelkarzinom des oberen Harntraktes. Urologe 51, 1228–1239 (2012). https://doi.org/10.1007/s00120-012-2911-9

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