Zum Hauptinhalt springen

Urothelkarzinom des oberen Harntraktes

Zuletzt bearbeitet: Zuletzt revidiert:
Zuletzt revidiert von:
Definition:
Upper Tract Urothelial Carcinomas (UTUC) sind Malignome, die vom Übergangsepithel (Urothel) der Harnwege und des Nierenbeckens ausgehen. Der größte Risikofaktor ist Rauchen.
Häufigkeit:
Geschätzte Inzidenz in industrialisierten Staaten: 2/100.000 pro Jahr. 
Symptome:
Mikro- oder Makrohämaturie in 80 % der Fälle, Flankenschmerzen in 20 % der Fälle.
Befunde:
Mikrohämaturie häufig als Zufallsbefund, klinischer Status in frühen Stadien meist unauffällig.
Diagnostik:
CT-Urografie (Goldstandard) ergänzt durch Urinzytologie und Zystoskopie.
Therapie:
Multimodales Therapiekonzept, eine Heilung kann nur durch eine operative Entfernung des Tumors erreicht werden. Ergänzend dazu zytostatische und Immuntherapie.
  1. Rouprêt M, Babjuk M, Burger M, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol. 2021 Jan;79(1):62-79. pubmed.ncbi.nlm.nih.gov  
  2. Rouprêt M, Babjuk M, Burger M, et al. EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma. Limited Update 2022. https://uroweb.org/guidelines. Letzte Suche am 29.03.2022. uroweb.org  
  3. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33. pubmed.ncbi.nlm.nih.gov  
  4. Cosentino M, Palou J, Gaya JM, et al. Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma. World J Urol. 2013 Feb;31(1):141-5. pubmed.ncbi.nlm.nih.gov  
  5. Soria F, Shariat SF, Lerner SP, Fritsche HM, Rink M, Kassouf W, Spiess PE, Lotan Y, Ye D, Fernández MI, Kikuchi E, Chade DC, Babjuk M, Grollman AP, Thalmann GN. Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol. 2017 Mar;35(3):379-387. pubmed.ncbi.nlm.nih.gov  
  6. Guruli G, Konety BR. Transitional cell carcinoma, renal. eMedicine, July 27, 2006. emedicine.medscape.com  
  7. Kirkali Z, Tuzel E. Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol 2003; 47: 155-69. PubMed  
  8. Michaelson MD, Kaufman DS, Oh WK. Transitional cell carcinoma of the upper uroepithelial tract. Clin Adv Hematol Oncol 2003; 1: 102-4. PubMed  
  9. Xylinas E, Kluth LA, Rieken M, Lee RK, Elghouayel M, Ficarra V, Margulis V, Lotan Y, Rouprêt M, et al. Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy. BJU Int. 2014 Jul;114(1):56-61. pubmed.ncbi.nlm.nih.gov  
  10. Chen CH, Grollman AP, Huang CY, et al. Additive Effects of Arsenic and Aristolochic Acid in Chemical Carcinogenesis of Upper Urinary Tract Urothelium. Cancer Epidemiol Biomarkers Prev. 2021 Feb;30(2):317-325. pubmed.ncbi.nlm.nih.gov  
  11. Chen CH, Dickman KG, Moriya M, et al. Aristolochic acid-associated urothelial cancer in Taiwan. Proc Natl Acad Sci U S A. 2012 May 22;109(21):8241-6. pubmed.ncbi.nlm.nih.gov  
  12. Rink M, Xylinas E, Margulis V, Cha EK, Ehdaie B, Raman JD, Chun FK, Matsumoto K, Lotan Y, et a. Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. Eur Urol. 2013 Jun;63(6):1082-90. pubmed.ncbi.nlm.nih.gov  
  13. Ju JY, Mills AM, Mahadevan MS, et al. Universal Lynch Syndrome Screening Should be Performed in All Upper Tract Urothelial Carcinomas. Am J Surg Pathol. 2018 Nov;42(11):1549-1555. pubmed.ncbi.nlm.nih.gov  
  14. Brierley, J.D., et al. TNM Classification of Malignant Tumours. 8th ed. 2016. www.uicc.org  
  15. Cowan NC. CT urography for hematuria. Nat Rev Urol. 2012 Mar 13;9(4):218-26. pubmed.ncbi.nlm.nih.gov  
  16. Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009 Mar 15;115(6):1224-33. pubmed.ncbi.nlm.nih.gov  
  17. Cowan NC, Turney BW, Taylor NJ, McCarthy CL, Crew JP. Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU Int. 2007 Jun;99(6):1363-70. pubmed.ncbi.nlm.nih.gov  
  18. Janisch F, Shariat SF, Baltzer P, et al. Diagnostic performance of multidetector computed tomographic (MDCTU) in upper tract urothelial carcinoma (UTUC): a systematic review and meta-analysis. World J Urol. 2020 May;38(5):1165-1175. pubmed.ncbi.nlm.nih.gov  
  19. Takahashi N, Glockner JF, Hartman RP, et al. Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. J Urol. 2010 Apr;183(4):1330-65. pubmed.ncbi.nlm.nih.gov  
  20. Millán-Rodríguez F, Palou J, de la Torre-Holguera P, Vayreda-Martija JM, Villavicencio-Mavrich H, Vicente-Rodríguez J. Conventional CT signs in staging transitional cell tumors of the upper urinary tract. Eur Urol. 1999 Apr;35(4):318-22. pubmed.ncbi.nlm.nih.gov  
  21. Malm C, Grahn A, Jaremko G, Tribukait B, Brehmer M. Diagnostic accuracy of upper tract urothelial carcinoma: how samples are collected matters. Scand J Urol. 2017 Apr;51(2):137-145. pubmed.ncbi.nlm.nih.gov  
  22. Witjes JA, Redorta JP, Jacqmin D, et al. Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations. Eur Urol. 2010 Apr;57(4):607-14. pubmed.ncbi.nlm.nih.gov  
  23. Lee KS, Zeikus E, DeWolf WC, Rofsky NM, Pedrosa I. MR urography versus retrograde pyelography/ureteroscopy for the exclusion of upper urinary tract malignancy. Clin Radiol. 2010 Mar;65(3):185-92. pubmed.ncbi.nlm.nih.gov  
  24. Seisen T, Peyronnet B, Dominguez-Escrig JL, et al. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel. Eur Urol. 2016 Dec;70(6):1052-1068. pubmed.ncbi.nlm.nih.gov  
  25. Raman J, Shore ND. Management of Low-grade Upper Tract Urothelial Carcinoma: An Unmet Need. Rev Urol. 2020;22(1):1-8. www.ncbi.nlm.nih.gov  
  26. Clements MB, Krupski TL, Culp SH. Robotic-Assisted Surgery for Upper Tract Urothelial Carcinoma: A Comparative Survival Analysis. Ann Surg Oncol. 2018 Sep;25(9):2550-2562. pubmed.ncbi.nlm.nih.gov  
  27. Dominguez-Escrig JL, Peyronnet B, Seisen T, Bruins HM, et al. Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer. Eur Urol Focus. 2019 Mar;5(2):224-241. pubmed.ncbi.nlm.nih.gov  
  28. Baard J, Cormio L, Cavadas V, et al. Contemporary patterns of presentation, diagnostics and management of upper tract urothelial cancer in 101 centres: the Clinical Research Office of the Endourological Society Global upper tract urothelial carcinoma registry. Curr Opin Urol. 2021 Jul 1;31(4):354-362. pubmed.ncbi.nlm.nih.gov  
  29. Cutress ML, Stewart GD, Wells-Cole S, Phipps S, et al. Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJU Int. 2012 Dec;110(11):1608-17. pubmed.ncbi.nlm.nih.gov  
  30. Cornu JN, Rouprêt M, Carpentier X, Geavlete B, et al. Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma. World J Urol. 2010 Apr;28(2):151-6. pubmed.ncbi.nlm.nih.gov  
  31. Villa L, Cloutier J, Letendre J, Ploumidis A, et al. Early repeated ureteroscopy within 6-8 weeks after a primary endoscopic treatment in patients with upper tract urothelial cell carcinoma: preliminary findings. World J Urol. 2016 Sep;34(9):1201-6. pubmed.ncbi.nlm.nih.gov  
  32. Matin SF, Margulis V, Kamat A, et al. Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer. 2010 Jul 1;116(13):3127-34. pubmed.ncbi.nlm.nih.gov  
  33. Margulis V, Puligandla M, Trabulsi EJ, et al. Phase II Trial of Neoadjuvant Systemic Chemotherapy Followed by Extirpative Surgery in Patients with High Grade Upper Tract Urothelial Carcinoma. J Urol. 2020 Apr;203(4):690-698. pubmed.ncbi.nlm.nih.gov  
  34. Meng X, Chao B, Vijay V, Silver H, et al. High Response Rates to Neoadjuvant Chemotherapy in High-Grade Upper Tract Urothelial Carcinoma. Urology. 2019 Jul;129:146-152. pubmed.ncbi.nlm.nih.gov  
  35. Remzi M, Schwentner C, Shariat S, Grubmüller B. Urothelkarzinom der Nieren und Harnleiter: Therapie. In: Die Urologie. Hrsg: Michel MS, Thüroff JW, Janetschek G, Wirth M. Springer-Verlag, 1. Aufl. 2016. 409-430.
  36. Tully KH, Krimphove Md MJ, Huynh MJ, et al. Differences in survival and impact of adjuvant chemotherapy in patients with variant histology of tumors of the renal pelvis. World J Urol. 2020 Sep;38(9):2227-2236. pubmed.ncbi.nlm.nih.gov  
  37. Vassilakopoulou M, de la Motte Rouge T, Colin P, et al. Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC): results from a large multicenter collaborative study. Cancer 2011; 117: 5500-8. doi:10.1002/cncr.26172 DOI  
  38. Gallioli A, Boissier R, Territo A, Vila Reyes H, et al. Adjuvant Single-Dose Upper Urinary Tract Instillation of Mitomycin C After Therapeutic Ureteroscopy for Upper Tract Urothelial Carcinoma: A Single-Centre Prospective Non-Randomized Trial. J Endourol. 2020 May;34(5):573-580. pubmed.ncbi.nlm.nih.gov  
  39. Giannarini G, Kessler TM, Birkhäuser FD, et al. Antegrade perfusion with bacillus Calmette-Guérin in patients with non-muscle-invasive urothelial carcinoma of the upper urinary tract: who may benefit? Eur Urol. 2011 Nov;60(5):955-60. pubmed.ncbi.nlm.nih.gov  
  40. Powles T, Csőszi T, Özgüroğlu M, et al. Pembrolizumab alone or combined with chemotherapy versus chemotherapy as first-line therapy for advanced urothelial carcinoma (KEYNOTE-361): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jul;22(7):931-945. pubmed.ncbi.nlm.nih.gov  
  41. Huang YC, Chang YH, Chiu KH, Shindel AW, Lai CH. Adjuvant radiotherapy for locally advanced upper tract urothelial carcinoma. Sci Rep. 2016 Dec 2;6:38175. pubmed.ncbi.nlm.nih.gov  
  42. Iwata T, Kimura S, Abufaraj M, Janisch F, et al. The role of adjuvant radiotherapy after surgery for upper and lower urinary tract urothelial carcinoma: A systematic review. Urol Oncol. 2019 Oct;37(10):659-671 pubmed.ncbi.nlm.nih.gov  
  43. Abe T, Shinohara N, Harabayashi T, et al. Impact of multimodal treatment on survival in patients with metastatic urothelial cancer. Eur Urol. 2007 Oct;52(4):1106-13. pubmed.ncbi.nlm.nih.gov  
  44. Tomita Y, Yamamoto Y, Tsuchiya N, et al. Avelumab first-line maintenance plus best supportive care (BSC) vs BSC alone for advanced urothelial carcinoma: JAVELIN Bladder 100 Japanese subgroup analysis. Int J Clin Oncol. 2022 Feb;27(2):383-395. pubmed.ncbi.nlm.nih.gov  
  45. Galsky MD, Mortazavi A, Milowsky MI, et al. Randomized Double-Blind Phase II Study of Maintenance Pembrolizumab Versus Placebo After First-Line Chemotherapy in Patients With Metastatic Urothelial Cancer. J Clin Oncol. 2020 Jun 1;38(16):1797-1806. pubmed.ncbi.nlm.nih.gov  
  46. Balar AV, Galsky MD, Rosenberg JE, et al. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet. 2017 Jan 7;389(10064):67-76. pubmed.ncbi.nlm.nih.gov  
  47. Sharma P, Retz M, Siefker-Radtke A, et al. Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2017 Mar;18(3):312-322. pubmed.ncbi.nlm.nih.gov  
  48. Bellmunt J, de Wit R, Vaughn DJ, et al. Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma. N Engl J Med. 2017 Mar 16;376(11):1015-1026. pubmed.ncbi.nlm.nih.gov  
  49. Nazzani S, Preisser F, Mazzone E, et al. Survival Effect of Nephroureterectomy in Metastatic Upper Urinary Tract Urothelial Carcinoma. Clin Genitourin Cancer. 2019 Jun;17(3):e602-e611. pubmed.ncbi.nlm.nih.gov  
  50. Lehmann J, Suttmann H, Albers P, et al. Surgery for metastatic urothelial carcinoma with curative intent: the German experience (AUO AB 30/05). Eur Urol. 2009 Jun;55(6):1293-9. pubmed.ncbi.nlm.nih.gov  
  51. Lemke E, Sahasrabudhe D, Guancial E, et al. The Role of Metastasectomy in Urothelial Carcinoma: Where Are We in 2020? Clin Genitourin Cancer. 2020 Aug;18(4):e478-e483. pubmed.ncbi.nlm.nih.gov  
  52. Simsir A, Sarsik B, Cureklibatir I, Sen S, Gunaydin G, Cal C. Prognostic factors for upper urinary tract urothelial carcinomas: stage, grade, and smoking status. Int Urol Nephrol. 2011 Dec;43(4):1039-45. pubmed.ncbi.nlm.nih.gov  
  53. Brien JC, Shariat SF, Herman MP, et al. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol. 2010 Jul;184(1):69-73 pubmed.ncbi.nlm.nih.gov  
  54. Collà Ruvolo C, Nocera L, Stolzenbach LF, et al. Tumor Size Predicts Muscle-invasive and Non-organ-confined Disease in Upper Tract Urothelial Carcinoma at Radical Nephroureterectomy. Eur Urol Focus. 2021 Mar 15:S2405-4569(21)00060-2. pubmed.ncbi.nlm.nih.gov  
  • Kristin Haavisto, Dr. med., Fachärztin für Innere Medizin und Hämato-/Onkologie, Münster