Aktive Überwachung beim Nierenzellkarzinom

Zusammenfassung

Die Inzidenz des Nierenzellkarzinom ist weiter steigend. Dabei nimmt der Anteil von Tumoren <4 cm deutlich zu. Nicht alle Tumoren sind hierbei maligne und nicht alle malignen Tumoren entsprechen einem Nierenzellkarzinom. Obgleich die partielle Nephrektomie den Therapiestandard darstellt, werden zunehmend Patienten mittels Kryoablation, Radiofrequenzablation oder aktiver Überwachung behandelt. Für letztgenannte Optionen ist eine prätherapeutische Tumorbiopsie zwingend zu fordern. Etwa 85% aller Biopsien sind im Hinblick auf die Dignität des Tumors auswertbar. Bei Vorliegen eines Nierenzellkarzinoms können histologischer Subtyp und Grading in 85 und 65% korrekt dargestellt werden. Unter aktiver Überwachung lässt sich derzeit nicht vorhersagen, welcher Tumor ein Größenwachstum bzw. eine Metastasierung zeigen wird. Ein späteres Größenwachstum stellt den Hautgrund für die Entscheidung zugunsten einer aktiven Therapie dar. In der vorliegenden Arbeit werden die Ergebnisse zur Nierentumorbiopsie und aktiven Überwachung von Nierentumoren vorgestellt.

Abstract

The incidence of renal cell carcinoma (RCC) and especially that of small RCCs is increasing. However, not all tumours are malignant and not all malignant tumours are RCCs. Although partial nephrectomy is the therapeutic standard of care, an increasing number of patients is being treated with cryoablation, radiofrequency ablation, or active surveillance. The latter options require a pretherapeutic tumour biopsy. Approximately 85% of all biopsies can distinguish benign from malignant tumours. In the case of a RCC, histological subtype and grading are correctly diagnosed in 85% and 65%, respectively. However, tumour growth and metastasis in patients undergoing active surveillance cannot be predicted. A later tumour growth is the main trigger to change to active therapy. In this paper the results of tumour biopsy and active surveillance of patients with a renal mass are presented.

Schlüsselwörter

Nierenzellkarzinom - natürlicher Verlauf - aktive Überwachung - Active Surveillance - Biopsie

Key words

kidney cancer - natural disease course - active surveillance - watchful waiting - biopsy

• Literatur

• 1 Cooperberg MR, Mallin K, Ritchey J et al. Decreasing size at diagnosis of stage 1 renal cell carcinoma: analysis from the National Cancer Data Base, 1993 to 2004. J Urol 2008; 179: 2131-2135
• 2 Kane CJ, Mallin K, Ritchey J et al. Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 2008; 113: 78-83
• 3 Chapin BF, Delacroix Jr SE, Wood CG. Renal cell carcinoma: what the surgeon and treating physician need to know. AJR Am J Roentgenol 2011; 196: 1255-1262
• 4 Stakhovskyi O, Yap SA, Leveridge M et al. Small renal mass: what the urologist needs to know for treatment planning and assessment of treatment results. AJR Am J Roentgenol 2011; 196: 1267-1273
• 5 Frank I, Blute ML, Cheville JC et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003; 170: 2217-2220
• 6 Thompson RH, Hill JR, Babayev Y et al. Metastatic renal cell carcinoma risk according to tumor size. J Urol 2009; 182: 41-45
• 7 Nguyen MM, Gill IS. Effect of renal cancer size on the prevalence of metastasis at diagnosis and mortality. J Urol 2009; 181: 1020-1027
• 8 Bonsib SM. T2 clear cell renal cell carcinoma is a rare entity: a study of 120 clear cell renal cell carcinomas. J Urol 2005; 174: 1199-1202
• 9 Volpe A, Kachura JR, Geddie WR et al. Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 2007; 178: 379-386
• 10 Gibbons RP, Bush Jr WH, Burnett LL. Needle tract seeding following aspiration of renal cell carcinoma. J Urol 1977; 118: 865-867
• 11 Kiser GC, Totonchy M, Barry JM. Needle tract seeding after percutaneous renal adenocarcinoma aspiration. J Urol 1986; 136: 1292-1293
• 12 Herts BR, Baker ME. The current role of percutaneous biopsy in the evaluation of renal masses. Semin Urol Oncol 1995; 13: 254-261
• 13 Wood BJ, Khan MA, McGovern F et al. Imaging guided biopsy of renal masses: indications, accuracy and impact on clinical management. J Urol 1999; 161: 1470-1474
• 14 Wunderlich H, Hindermann W, Al Mustafa AM et al. The accuracy of 250 fine needle biopsies of renal tumors. J Urol 2005; 174: 44-46
• 15 Reichelt O, Gajda M, Chyhrai A et al. Ultrasound-guided biopsy of homogenous solid renal masses. Eur Urol 2007; 52: 1421-1426
• 16 Schmidbauer J, Remzi M, Memarsadeghi M et al. Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses. Eur Urol 2008; 53: 1003-1011
• 17 Shannon BA, Cohen RJ, de Bruto H et al. The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses. J Urol 2008; 180: 1257-1261
• 18 Volpe A, Mattar K, Finelli A et al. Contemporary results of percutaneous biopsy of 100 small renal masses: a single center experience. J Urol 2008; 180: 2333-2337
• 19 Veltri A, Garetto I, Tosetti I et al. Diagnostic accuracy and clinical impact of imaging-guided needle biopsy of renal masses. Retrospective analysis on 150 cases. Eur Radiol 2011; 21: 393-401
• 20 Remzi M, Marberger M. Renal tumor biopsies for evaluation of small renal tumors: why, in whom, and how?. Eur Urol 2009; 55: 359-367
• 21 Leveridge MJ, Finelli A, Kachura JR et al. Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol 2011; 60: 578-584
• 22 Chawla SN, Crispen PL, Hanlon AL et al. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 2006; 175: 425-431
• 23 Kouba E, Smith A, McRackan D et al. Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention. J Urol 2007; 177: 466-470
• 24 Siu W, Hafez KS, Johnston 3rd WK et al. Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol 2007; 25: 115-119
• 25 Abouassaly R, Lane BR, Novick AC. Active surveillance of renal masses in elderly patients. J Urol 2008; 180: 505-508
• 26 Crispen PL, Viterbo R, Fox EB et al. Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer 2008; 112: 1051-1057
• 27 Lane BR, Abouassaly R, Gao T et al. Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer 2010; 116: 3119-3126
• 28 Jewett MA, Mattar K, Basiuk J et al. Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol 2011; 60: 39-44
• 29 Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma – a meta-analysis and review. J Urol 2008; 179: 1227-1233
• 30 Volpe A, Cadeddu JA, Cestari A et al. Contemporary management of small renal masses. Eur Urol 2011; 60: 501-515
• 31 Van Poppel H, Becker F, Cadeddu JA et al. Treatment of localised renal cell carcinoma. Eur Urol 2011; 60: 662-672
• 32 Smaldone MC, Kutikov A, Egleston BL et al. Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 2012; 118: 997-1006
• 33 Crispen PL, Viterbo R, Boorjian SA et al. Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer 2009; 115: 2844-2852
• 34 Kawaguchi S, Fernandes KA, Finelli A et al. Most renal oncocytomas appear to grow: observations of tumor kinetics with active surveillance. J Urol 2011; 186: 1218-1222
• 35 Volpe A, Jewett MA. The role of surveillance for small renal masses. Nat Clin Pract Urol 2007; 4: 2-3