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Aktuelle TNM-Klassifikationssysteme für das Nebennierenkarzinom

Current TNM classification systems for adrenocortical carcinoma

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Zusammenfassung

Das Nebennierenkarzinom ist ein seltener Tumor, der oft schwierig zu diagnostizieren ist. 2003 wurde durch die UICC erstmals ein Vorschlag zur Klassifikation der anatomischen Ausbreitung veröffentlicht. Dieser Vorschlag wurde 2010 von AJCC und UICC in die 7. Auflage der TNM-Klassifikation übernommen. Allerdings hatte eine Überprüfung dieser Klassifikation an zwei großen Patientenkollektiven Schwächen dieser UICC-Klassifikation aufgedeckt. Insbesondere ist die Prognose der Patienten im Stadium II und III der UICC-Klassifikation nicht signifikant unterschiedlich. Vom „European Network for the Study of Adrenal Tumours“ (ENSAT) wurde daraufhin eine TNM-Revision vorgeschlagen. Hierbei werden lokalisierte Tumoren als Tumorstadium I bzw. II bezeichnet, wobei die Unterscheidung sich durch die Größe des Tumors ≤5 cm bzw. >5 cm ergibt. Das Stadium III ist definiert über den Nachweis positiver Lymphknoten, eine Infiltration in das benachbarte Gewebe oder einen venösen Tumorthrombus. Stadium IV ist Patienten mit Fernmetastasen vorbehalten. Da die ENSAT-Klassifikation die Prognose der Patienten deutlich besser widerspiegelt als die UICC-Klassifikation, sollte aktuell dieses System verwendet werden. Zusätzlich ist die genaue Beurteilung des Resektionsstatus für eine optimale weitere Patientenversorgung essenziell.

Abstract

Adrenocortical carcinoma (ACC) is a rare malignancy and often difficult to diagnose. It was only in 2003 that the UICC proposed the first TNM classification for ACC. However, an analysis based on data from the German ACC Registry revealed several shortcomings of this classification; in particular, the outcome of patients with UICC stage II and III was not significantly different. Therefore, the European Network for the Study of Adrenal Tumours (ENSAT) developed a revised staging system, the superiority of which was recently confirmed in an independent American cohort. In the ENSAT classification, stage I (tumors ≤5 cm) and II (tumors <5 cm) are non-infiltrating tumors without positive lymph nodes and distant metastases. Stage III is defined by the presence of positive lymph nodes, infiltration of surrounding tissue, or venous tumor thrombus. Stage IV is restricted to patients with distant metastasis. Since the ENSAT classification better reflects patient prognosis than the UICC classification, its use for future clinical and research purposes is recommended. Furthermore, exact documentation of the resection status is essential for optimal decisions on treatment.

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Danksagung

Die der Arbeit zugrunde liegenden Studien wurde durch Mittel des BMBF, der Deutschen Krebshilfe und der Deutschen Forschungsgemeinschaft für M. Fassnacht und B. Allolio unterstützt.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik I, Schwerpunkt Endokrinologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    M. Fassnacht & B. Allolio

  2. Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    C. Wittekind

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  1. M. Fassnacht
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  2. C. Wittekind
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  3. B. Allolio
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Correspondence to M. Fassnacht.

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Fassnacht, M., Wittekind, C. & Allolio, B. Aktuelle TNM-Klassifikationssysteme für das Nebennierenkarzinom. Pathologe 31, 374–378 (2010). https://doi.org/10.1007/s00292-010-1306-1

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