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Die Gynäkologie

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01.12.2015 | Leitthema

Prognosefaktoren gynäkologischer Malignome

verfasst von: PD Dr. M. T. v. Mackelenbergh, Prof. Dr. C. Mundhenke

Erschienen in: Die Gynäkologie | Ausgabe 12/2015

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Zusammenfassung

Prognostische und prädiktive Faktoren sollen bei der Primärdiagnose, aber auch beim metastasierten Mammakarzinom dazu beitragen, auf die jeweilige Erkrankungssituation und Patientin „zugeschnittene“ Therapiemaßnahmen auszuwählen. Prognose bedeutet die Vorhersage des Rückfallrisikos oder Sterberisikos nach Diagnosestellung. Die klinisch-pathologischen Faktoren (Tumorgröße, Nodal, Hormonrezeptorstatus, Grading, Lymphangioinvasion, zirkulierende Tumorzellen) sind gut als Prognosefaktoren validiert. Neue Multigenassays ergeben eine zusätzliche prognostische Einschätzung, sind aber als prädiktive Marker nicht hinreichend validiert; sinnvoll könnte die Kombination mit klinisch-pathologischen Faktoren und Proteintests sein. Insbesondere könnten Patientinnen profitieren, bei denen allein aufgrund der klinisch-pathologischen Faktoren eine adjuvanten Systemtherapie nicht eindeutig zu empfehlen ist. Beim Ovarialkarzinom sind die klinisch-pathologischen Faktoren (Stadium, Tumorrest, Grading, Alter, Allgemeinzustand) von entscheidender Bedeutung. Die BRCA-Testung ist bei Patientinnen mit platinsensiblen Rezidiven besonders relevant, da Mutationsträgerinnen entscheidend vom Einsatz der PARP-Inhibitoren profitieren. Die Prognose des Endometriumkarzinoms wird neben den klinisch-pathologischen Parametern erheblich durch den histologischen Subtyp bestimmt. Es gilt, künftig Mutationsanalysen und Multigenassays auch für die gynäkologischen Tumoren zu etablieren, um die Therapieoptionen zu verbessern.

Goldhirsch A et al (2007) 10. St. Gallen Conference. Ann Oncol 18(7):1133–1442 (Jul)CrossRefPubMed

Varma S et al (2014) Complexities and challenges in the pathologic assessment of size (t) of invasive breast carcinoma. Adv Anat Pathol 21(3):420–432CrossRefPubMed

Tot T et al (2011) Breast cancer multifocality, disease extent, and survival. Hum Pathol 42:1761.4–1769.4CrossRef

Moran MS et al (2014) Society of surgical oncology-american society for radiation oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages i and ii invasive breast cancer. Int J Radiat Oncol Biol Phys 88(5):553–564CrossRefPubMed

Houssami N et al (2014) The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 21:717–730CrossRefPubMed

Houssami N, Morrow M (2014) Margins in breast conservation: a clinician’s perspective and what the literature tells us. J Surg Oncol 110:2–7CrossRefPubMed

Banerjee S et al (2006) Basal-like breast carcinomas: clinical outcome and response to chemotherapy. J Clin Pathol 59(7):729–7357PubMedCentralCrossRefPubMed

Kroman N et al (2000) Factors influencing the effect of age on prognosis in breast cancer: population based study. Br Med J 320:474–4798CrossRef

Salgado R et al (2015) The evaluation of tumor-infiltrating lymphocytes (tils) in breast cancer: recommendations by an international tils working group 2014. Ann Oncol 26:259.9–271.9 (official journal of the European Society for Medical Oncology/ESMO)CrossRef

10.

Denkert C et al (2015) Tumor-infiltrating lymphocytes and response to neoadjuvant chemotherapy with or without carboplatin in human epidermal growth factor receptor 2-positive and triple-negative primary breast cancers. J Clin Oncol 33:983–991CrossRefPubMed

11.

Sahoo S, Lester SC (2009) Pathology of breast carcinomas after neoadjuvant chemotherapy: an overview with recommendations on specimen processing and reporting. Arch Pathol Lab Med 133(12):633–642PubMed

12.

Symmans WF et al (2007) Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol 25:4414.13–4422.13CrossRef

13.

Gujam FJ et al (2014) The role of lymphatic and blood vessel invasion in predicting survival and methods of detection in patients with primary operable breast cancer. Crit Rev Oncol 89:231.14–241.14CrossRef

14.

Schoppmann SF, Austrian Breast and Colorectal Cancer Study Group et al (2004) Prognostic value of lymphangiogenesis and lymphovascular invasion in invasive breast cancer. Ann Surg 240(2):306–31215PubMedCentralCrossRefPubMed

15.

Gloyeske NC et al (2014) Low er+ breast cancer: is this a distinct group. Am J Clin Pathol 141:697–701CrossRefPubMed

16.

Prat A et al (2013) Prognostic significance of progesterone receptor-positive tumor cells within immunohistochemically defined luminal a breast cancer. J Clin Oncol 31:203–209PubMedCentralCrossRefPubMed

17.

Hefti MM et al (2013) Estrogen receptor negative/progesterone receptor positive breast cancer is not a reproducible subtype. Breast Cancer Res 15:R68.18CrossRef

18.

Chapman JA et al (2006) Ascertaining prognosis for breast cancer in node-negative patients with innovative survival analysis. Breast J 12(1):37–4719CrossRefPubMed

19.

Bardou VJ et al (2003) Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases. J Clin Oncol 21(10):1973–197920CrossRefPubMed

20.

Viale G et al (2007) Prognostic and predictive value of centrally reviewed expression of estrogen and progesterone receptors in a randomized trial comparing letrozole and tamoxifen adjuvant therapy for postmenopausal early breast cancer: BIG 1-98. J Clin Oncol 25(25):3846–3852CrossRefPubMed

21.

Urban P et al (2006) Increased expression of urokinase-type plasminogen activator mRNA determines adverse prognosis in ErbB2-positive primary breast cancer. J Clin Oncol 24:4245–4253CrossRefPubMed

22.

Konecny G et al (2001) Her2/neu and urokinase-type plasminogen activator and its inhibitor in breast cancer. Clin Cancer Res 7(8):2448–2457PubMed

23.

Moliterni A et al (2003) HER2 overexpression and doxorubicin in adjuvant chemotherapy for resectable breast cancer. J Clin Oncol 21(3):458–462CrossRefPubMed

24.

Seidman AD et al (2001) Weekly trastuzumab and paclitaxel therapy for metastatic breast cancer with analysis of efficacy by HER2 immunophenotype and gene amplification. J Clin Oncol 19(10):2587–2595PubMed

25.

Piccart-Gebhart MJ, Herceptin Adjuvant (HERA) Trial Study Team et al (2005) Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 353(16):1659–1672CrossRefPubMed

26.

Romond EH et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353(16):1673–1684CrossRefPubMed

27.

Slamon D et al (2006) BCIRG 006: 2nd interim analysis phase III randomized trial comparing doxorubicin and cyclophosphamide followed by docetaxel (AC→T) with doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (AC→TH) with docetaxel, carboplatin and trastuzumab (TCH) in Her2neu positive early breast cancer patients. Breast Cancer Res Treat 100:S1 (abstract #52)

28.

Joensuu H et al (2006) FinHer Study Investigators. Adjuvant docetaxel or vinorelbine with or without trastuzumab for breast cancer. N Engl J Med 354(8):809–820CrossRefPubMed

29.

Polley MY et al (2013) An international ki67 reproducibility study. J Natl Cancer Inst 105:1897–1906PubMedCentralCrossRefPubMed

30.

Van De Vijver M, He YD, Van’T Veer L et al (2002) A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med 347:1999–2009CrossRefPubMed

31.

Chan DS et al (2014) Body mass index and survival in women with breast cancer - systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 25:1901–1914PubMedCentralCrossRefPubMed

32.

Braun S et al (2005) A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med 353:793–802CrossRefPubMed

33.

Cristofanilli M et al (2004) Circulating tumor cells, disease progression and survival in metastatic breast cancer. N Engl J Med 351:781–791CrossRefPubMed

34.

Drukker CA et al (2014) Gene expression profiling to predict the risk of locoregional recurrence in breast cancer: a pooled analysis. Breast Cancer Res Treat 148:599–613 (Erratum in: Breast Cancer Res Treat 2015;149:567)CrossRefPubMed

35.

Fitzal F et al (2014) Predicting local recurrence using PAM50 in postmenopausal endocrine responsive breast cancer patients. J Clin Oncol 32(suppl):5s (abstr 1008)

36.

Harbeck N (2013) Ten-year analysis of the prospective multicentre chemo-n0 trial validates american society of clinical oncology (asco)-recommended biomarkers upa and pai-1 for therapy decision making in node-negative breast cancer patients. Eur J Cancer 49:1825–1835CrossRefPubMed

37.

Liu S et al (2015) Prognostic and predictive investigation of pam50 intrinsic subtypes in the ncic ctg ma.21 phase iii chemotherapy trial. Breast Cancer Res Treat 149:439–448CrossRefPubMed

38.

Sestak I et al (2015) Prediction of late distant recurrence after 5 years of endocrine treatment: a combined analysis of patients from the austrian breast and colorectal cancer study group 8 and arimidex, tamoxifen alone or in combination randomized trials using the pam50 risk of recurrence score. J Clin Oncol 33:916–922CrossRefPubMed

39.

Harbeck N et al (2001) Clinical relevance of the plasminogen activator inhibitor type 1 – a multifaceted proteolytic factor. Onkologie 24(3):238–244CrossRefPubMed

40.

Prat J, FIGO Committee on Gynecologic Oncology (2015) Abridged republication of FIGO’s staging classification for cancer of the ovary, fallopian tube, and peritoneum. Cancer 126(1):171–174

41.

du Bois A et al (2009) A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 115(6):1234–1244 (Mar 15)CrossRefPubMed

42.

Miyamoto M et al (2013) Clear cell histology as a poor prognostic factor for advanced epithelial ovarian cancer: a single institutional case series through central pathologic review. J Gynecol Oncol 24(1):37–43 (Jan)PubMedCentralCrossRefPubMed

43.

Malpica A et al (2004) Grading ovarian serous carcinoma using a two-tier system. Am J Surg Pathol 28(4):496–504 (Apr)CrossRefPubMed

44.

Ledermann J et al (2014) Olaparib maintenance therapy in patients with platinum-sensitive relapsed serous ovarian cancer: a preplanned retrospective analysis of outcomes by BRCA status in a randomised phase 2 trial. Lancet Oncol 15:852–861CrossRefPubMed

45.

Keys HM et al (2004) Gynecologic Oncology Group. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 92(3):744–751 (Mar)CrossRefPubMed

46.

Zaino RJ et al (1996) Pathologic models to predict outcome for women with endometrial adenocarcinoma: the importance of the distinction between surgical stage and clinical stage--a Gynecologic Oncology Group study. Cancer 77(6):1115–1121 (Mar 15)CrossRefPubMed

47.

Bokhman JV (1983) Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 15(1):10–17 (Feb)CrossRefPubMed

48.

Hecht JL, Mutter GL (2006) Molecular and pathologic aspects of endometrial carcinogenesis. J Clin Oncol 24(29):4783–4791 (Oct 1)CrossRefPubMed

49.

Creasman WT et al (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60(Suppl 8):2035–2041 (Oct 15)CrossRefPubMed

50.

Morrow CP et al (1991) Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 40(1):55–65 (Jan)CrossRefPubMed

51.

Creasman WT et al (1999) Significance of true surgical pathologic staging: a Gynecologic Oncology Group Study. Am J Obstet Gynecol 181(1):31–34 (Jul)CrossRefPubMed

52.

Boronow RC et al (1984) Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 63(6):825–832 (Jun)PubMed

53.

Creasman WT et al (1985) Influence of cytoplasmic steroid receptor content on prognosis of early stage endometrial carcinoma. Am J Obstet Gynecol 151(7):922–932 (Apr 1)CrossRefPubMed

54.

Palmer DC et al (1988) The prognostic importance of steroid receptors in endometrial carcinoma. Obstet Gynecol 72(3 Pt 1):388–393 (Sep)PubMed

55.

Hayes MP et al (2006) PIK3CA and PTEN mutations in uterine endometrioid carcinoma and complex atypical hyperplasia. Clin Cancer Res 12(20 Pt 1):5932–5935 (Oct 15)CrossRefPubMed

56.

Mutter GL et al (2000) Altered PTEN expression as a diagnostic marker for the earliest endometrial precancers. J Natl Cancer Inst 92(11):924–930 (Jun 7)CrossRefPubMed

57.

Weigelt B, Banerjee S (2012) Molecular targets and targeted therapeutics in endometrial cancer. Curr Opin Oncol 24(5):554–563 (Sep)CrossRefPubMed

58.

Lee EJ et al (2010) p53 alteration independently predicts poor outcomes in patients with endometrial cancer: a clinicopathologic study of 131 cases and literature review. Gynecol Oncol 116(3):533–538 (Mar)CrossRefPubMed

59.

Saffari B et al (2005) Association of p53 mutations and a codon 72 single nucleotide polymorphism with lower overall survival and responsiveness to adjuvant radiotherapy in endometrioid endometrial carcinomas. Int J Gynecol Cancer 15(5):952–963 (Sep-Oct)CrossRefPubMed

60.

Basil JB et al (2000) Clinical significance of microsatellite instability in endometrial carcinoma. Cancer 89(8):1758–1764 (Oct 15)CrossRefPubMed

61.

Zighelboim I et al (2015) Assessing the prognostic role of ATR mutation in endometrioid endometrial cancer: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 138(3):614–619 (Sep)CrossRefPubMed

Titel: Prognosefaktoren gynäkologischer Malignome
verfasst von: PD Dr. M. T. v. Mackelenbergh
Prof. Dr. C. Mundhenke
Publikationsdatum: 01.12.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Die Gynäkologie / Ausgabe 12/2015
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI: https://doi.org/10.1007/s00129-015-3795-8

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