nach oben

Die Urologie

Erschienen in:

16.09.2020 | Computertomografie | CME

Urothelkarzinom des oberen Harntrakts

verfasst von: Prof. Dr. A. J. Gross, C. Netsch, J.-U. Stolzenburg, B. Becker

Erschienen in: Die Urologie | Ausgabe 10/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Das Urothelkarzinom des oberen Harntrakts (UTUC) ist eine seltene Entität. Die Inzidenz liegt in Deutschland derzeit bei etwa 2/100.000 mit einem Verhältnis zwischen Frauen und Männern von 1:2,5. Die meisten klinischen Zeichen sind unspezifisch und unergiebig, weswegen eine frühzeitige Diagnosestellung nur selten gelingt. Die Computertomographie mit Kontrastmittel und Urographiephase bildet gemeinsam mit der diagnostischen Ureterorenoskopie aktuell den Goldstandard in der Diagnostik des UTUC. Bei der operativen Behandlung des UTUC bleibt derzeit die radikale Nephroureterektomie (RNU) unter Mitnahme einer Blasenmanschette das Mittel der Wahl, obgleich sich das radikale Vorgehen hin zu laparoskopischen/robotischen oder endourologischen Verfahren unter Erhalt der Niere entwickelt. Aufgrund der hohen Rezidivrate (22–47 %) eines Urothelkarzinoms in der Harnblase sind engmaschige Verlaufskontrollen nach RNU obligat.

Green DA, Rink M, Xylinas E et al (2013) Urothelial carcinoma of the bladder and the upper tract: disparate twins. J Urol 189:1214–1221. https://doi.org/10.1016/j.juro.2012.05.079CrossRefPubMed

Leitlinienprogramm Onkologie (2020) Leitlinie Harnblasenkarzinom. https://www.Leitlinienprogramm-onkologie.de/Harnblasenkarzinom.92.0.html. Zugegriffen: 17. Apr. 2020

https://www.krebsdaten.de/Krebs/DE/Content/Krebsarten/Harnblasenkrebs/harnblasenkrebs_node.html;jsessionid=CF04A84E695E86EC256A07367250AF35.2_cid372. Zugegriffen: 03.09.2020

Soria F, Shariat SF, Lerner SP et al (2017) Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol 35:379–387. https://doi.org/10.1007/s00345-016-1928-xCrossRefPubMed

Cosentino M, Palou J, Gaya JM et al (2013) Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma. World J Urol 31:141–145. https://doi.org/10.1007/s00345-012-0877-2CrossRefPubMed

Lammers RJM, Witjes WPJ, Hendricksen K et al (2011) Smoking status is a risk factor for recurrence after transurethral resection of non-muscle-invasive bladder cancer. Eur Urol 60:713–720. https://doi.org/10.1016/j.eururo.2011.07.010CrossRefPubMed

Crivelli JJ, Xylinas E, Kluth LA et al (2014) Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature. Eur Urol 65:742–754. https://doi.org/10.1016/j.eururo.2013.06.010CrossRef

Cosyns J‑P (2003) Aristolochic acid and “Chinese herbs nephropathy”: a review of the evidence to date. Drug Saf 26:33–48. https://doi.org/10.2165/00002018-200326010-00004CrossRefPubMed

Ju JY, Mills AM, Mahadevan MS et al (2018) Universal Lynch syndrome screening should be performed in all upper tract urothelial carcinomas. Am J Surg Pathol 42:1549–1555. https://doi.org/10.1097/PAS.0000000000001141CrossRefPubMed

10.

Jung H, Gleason JM, Loo RK et al (2011) Association of hematuria on microscopic urinalysis and risk of urinary tract cancer. J Urol 185:1698–1703. https://doi.org/10.1016/j.juro.2010.12.093CrossRefPubMed

11.

Janisch F, Shariat SF, Baltzer P et al (2020) Diagnostic performance of multidetector computed tomographic (MDCTU) in upper tract urothelial carcinoma (UTUC): a systematic review and meta-analysis. World J Urol 38:1165–1175. https://doi.org/10.1007/s00345-019-02875-8CrossRefPubMed

12.

Takahashi N, Glockner JF, Hartman RP et al (2010) Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. J Urol 183:1330–1365. https://doi.org/10.1016/j.juro.2009.12.031CrossRefPubMed

13.

Fojecki G, Magnusson A, Traxer O et al (2019) Consultation on UTUC, Stockholm 2018 aspects of diagnosis of upper tract urothelial carcinoma. World J Urol 37:2271–2278. https://doi.org/10.1007/s00345-019-02732-8CrossRefPubMedPubMedCentral

14.

Messer J, Shariat SF, Brien JC et al (2011) Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma. BJU Int 108:701–705. https://doi.org/10.1111/j.1464-410X.2010.09899.xCrossRefPubMed

15.

Jin H, Lin T, Hao J et al (2018) A comprehensive comparison of fluorescence in situ hybridization and cytology for the detection of upper urinary tract urothelial carcinoma: a systematic review and meta-analysis. Medicine 97:e13859. https://doi.org/10.1097/MD.0000000000013859CrossRefPubMedPubMedCentral

16.

Sassa N, Iwata H, Kato M et al (2019) Diagnostic utility of UroVysion combined with conventional urinary cytology for urothelial carcinoma of the upper urinary tract. Am J Clin Pathol 151:469–478. https://doi.org/10.1093/ajcp/aqy170CrossRefPubMed

17.

Guo R‑Q, Hong P, Xiong G‑Y et al (2018) Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta-analysis. BJU Int 121:184–193. https://doi.org/10.1111/bju.14053CrossRefPubMed

18.

Marchioni M, Primiceri G, Cindolo L et al (2017) Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta-analysis. BJU Int 120:313–319. https://doi.org/10.1111/bju.13935CrossRefPubMed

19.

Golan S, Nadu A, Lifshitz D (2015) The role of diagnostic ureteroscopy in the era of computed tomography urography. BMC Urol 15:74. https://doi.org/10.1186/s12894-015-0068-8CrossRefPubMedPubMedCentral

20.

Tavora F, Fajardo DA, Lee TK et al (2009) Small endoscopic biopsies of the ureter and renal pelvis: pathologic pitfalls. Am J Surg Pathol 33:1540–1546. https://doi.org/10.1097/PAS.0b013e3181aec42aCrossRefPubMed

21.

Potretzke AM, Knight BA, Vetter JM et al (2016) Diagnostic utility of selective upper tract urinary cytology: a systematic review and meta-analysis of the literature. Urology 96:35–43. https://doi.org/10.1016/j.urology.2016.04.030CrossRefPubMed

22.

Breda A, Territo A, Guttilla A et al (2018) Correlation between confocal laser endomicroscopy (Cellvizio®) and histological grading of upper tract urothelial carcinoma: a step forward for a better selection of patients suitable for conservative management. Eur Urol Focus 4:954–959. https://doi.org/10.1016/j.euf.2017.05.008CrossRefPubMed

23.

Osman E, Alnaib Z, Kumar N (2017) Photodynamic diagnosis in upper urinary tract urothelial carcinoma: a systematic review. Arab J Urol 15:100–109. https://doi.org/10.1016/j.aju.2017.01.003CrossRefPubMedPubMedCentral

24.

Pearce S, Daneshmand S (2018) Enhanced endoscopy in bladder cancer. Curr Urol Rep 19:84. https://doi.org/10.1007/s11934-018-0833-9CrossRefPubMed

25.

Yoshida T, Setsuda S, Ishizuka M et al (2020) Photodynamic diagnosis with oral 5‑aminolevulinic acid for upper urinary tract carcinoma: a prospective clinical trial. J Endourol 34:509–515. https://doi.org/10.1089/end.2019.0725CrossRefPubMed

26.

Lughezzani G, Sun M, Perrotte P et al (2010) Should bladder cuff excision remain the standard of care at nephroureterectomy in patients with urothelial carcinoma of the renal pelvis? A population-based study. Eur Urol 57:956–962. https://doi.org/10.1016/j.eururo.2009.12.001CrossRefPubMed

27.

Gakis G, Schubert T, Alemozaffar M et al (2017) Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease. World J Urol 35:327–335. https://doi.org/10.1007/s00345-016-1819-1CrossRefPubMed

28.

Cutress ML, Stewart GD, Tudor ECG et al (2013) Endoscopic versus laparoscopic management of noninvasive upper tract urothelial carcinoma: 20-year single center experience. J Urol 189:2054–2060. https://doi.org/10.1016/j.juro.2012.12.006CrossRefPubMed

29.

Seisen T, Peyronnet B, Dominguez-Escrig JL et al (2016) 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 70:1052–1068. https://doi.org/10.1016/j.eururo.2016.07.014CrossRefPubMed

30.

Campos-Sañudo JA, Ballestero-Diego R, Zubillaga-Guerrero S et al (2020) Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events. Actas Urol Esp 44:239–244. https://doi.org/10.1016/j.acuro.2020.02.003CrossRefPubMed

31.

Rouprêt M, Babjuk M, Compérat E et al (2018) European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol 73:111–122. https://doi.org/10.1016/j.eururo.2017.07.036CrossRefPubMed

32.

Raman JD, Jafri SM (2016) Complications following radical nephroureterectomy. Curr Urol Rep 17:36. https://doi.org/10.1007/s11934-016-0595-1CrossRefPubMed

33.

Langer C, Becker H (2006) Treatment of abdominal wall defects, including abdominal relaxation. Chirurg 77:414–423. https://doi.org/10.1007/s00104-006-1186-3CrossRefPubMed

34.

Rosiello G, Palumbo C, Deuker M et al (2020) Preoperative frailty predicts adverse short-term postoperative outcomes in patients treated with radical nephroureterectomy. J Surg Oncol 121:688–696. https://doi.org/10.1002/jso.25840CrossRefPubMed

35.

Zeng S, Dai L, Yang J et al (2019) Development and external validation of a nomogram predicting prognosis of upper tract urothelial carcinoma after radical nephroureterectomy. Urol Oncol 37:290.e17–290.e24. https://doi.org/10.1016/j.urolonc.2018.12.027CrossRef

36.

Clayman RV, Kavoussi LR, Figenshau RS et al (1991) Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg 1:343–349. https://doi.org/10.1089/lps.1991.1.343CrossRefPubMed

37.

Ni S, Tao W, Chen Q et al (2012) Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol 61:1142–1153. https://doi.org/10.1016/j.eururo.2012.02.019CrossRefPubMed

38.

Rodriguez JF, Packiam VT, Boysen WR et al (2017) Utilization and outcomes of nephroureterectomy for upper tract urothelial carcinoma by surgical approach. J Endourol 31:661–665. https://doi.org/10.1089/end.2017.0086CrossRefPubMed

39.

Nazzani S, Preisser F, Mazzone E et al (2019) Survival effect of nephroureterectomy in metastatic upper urinary tract urothelial carcinoma. Clin Genitourin Cancer 17:e602–e611. https://doi.org/10.1016/j.clgc.2019.03.003CrossRefPubMed

40.

Palou J, Piovesan LF, Huguet J et al (2004) Percutaneous nephroscopic management of upper urinary tract transitional cell carcinoma: recurrence and long-term followup. J Urol 172:66–69. https://doi.org/10.1097/01.ju.0000132128.79974.dbCrossRefPubMed

41.

Scotland KB, Kleinmann N, Cason D et al (2018) Ureteroscopic management of large ≥2 cm upper tract urothelial carcinoma: a comprehensive 23-year experience. Urology 121:66–73. https://doi.org/10.1016/j.urology.2018.05.042CrossRefPubMed

42.

Defidio L, Antonucci M, De Dominicis M et al (2019) Thulium-holmium:YAG duo laser in conservative upper tract urothelial cancer treatment: 13 years experience from a tertiary national referral center. J Endourol 33:902–908. https://doi.org/10.1089/end.2019.0308CrossRefPubMed

43.

Yoo S, You D, Song C et al (2017) Risk of intravesical recurrence after ureteroscopic biopsy for upper tract urothelial carcinoma: Does the location matter? J Endourol 31:259–265. https://doi.org/10.1089/end.2016.0611CrossRefPubMed

44.

Verges DP, Lallas CD, Hubosky SG, Bagley DH (2017) Endoscopic treatment of upper tract urothelial carcinoma. Curr Urol Rep 18:31. https://doi.org/10.1007/s11934-017-0675-xCrossRefPubMed

45.

Huang G‑L, Luo H‑L, Chiang P‑H (2019) Does preoperative percutaneous nephrostomy insertion worsen upper-tract urothelial cancer oncological outcome? A retrospective single center study. BMC Urol 19:50. https://doi.org/10.1186/s12894-019-0482-4CrossRefPubMedPubMedCentral

46.

Raman JD, Park R (2017) Endoscopic management of upper-tract urothelial carcinoma. Expert Rev Anticancer Ther 17:545–554. https://doi.org/10.1080/14737140.2017.1326823CrossRefPubMed

47.

Matin SF, Margulis V, Kamat A et al (2010) Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer 116:3127–3134. https://doi.org/10.1002/cncr.25050CrossRefPubMed

48.

Liao RS, Gupta M, Schwen ZR et al (2018) Comparison of pathological stage in patients treated with and without neoadjuvant chemotherapy for high risk upper tract urothelial carcinoma. J Urol 200:68–73. https://doi.org/10.1016/j.juro.2017.12.054CrossRefPubMed

49.

Leow JJ, Martin-Doyle W, Fay AP et al (2014) A systematic review and meta-analysis of adjuvant and neoadjuvant chemotherapy for upper tract urothelial carcinoma. Eur Urol 66:529–541. https://doi.org/10.1016/j.eururo.2014.03.003CrossRefPubMed

50.

Seisen T, Krasnow RE, Bellmunt J et al (2017) Effectiveness of adjuvant chemotherapy after radical nephroureterectomy for locally advanced and/or positive regional lymph node upper tract urothelial carcinoma. J Clin Oncol 35:852–860. https://doi.org/10.1200/JCO.2016.69.4141CrossRefPubMed

51.

Necchi A, Lo Vullo S, Mariani L et al (2018) Adjuvant chemotherapy after radical nephroureterectomy does not improve survival in patients with upper tract urothelial carcinoma: a joint study by the European Association of Urology-Young Academic Urologists and the Upper Tract Urothelial Carcinoma Collaboration. BJU Int 121:252–259. https://doi.org/10.1111/bju.14020CrossRefPubMed

52.

Birtle A, Johnson M, Chester J et al (2020) Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial. Lancet 395:1268–1277. https://doi.org/10.1016/S0140-6736(20)30415-3CrossRefPubMedPubMedCentral

53.

Balar AV, Castellano D, O’Donnell PH et al (2017) First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study. Lancet Oncol 18:1483–1492. https://doi.org/10.1016/S1470-2045(17)30616-2CrossRef

54.

Balar AV, Galsky MD, Rosenberg JE et al (2017) Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 389:67–76. https://doi.org/10.1016/S0140-6736(16)32455-2CrossRefPubMed

55.

Seisen T, Colin P, Rouprêt M (2015) Risk-adapted strategy for the kidney-sparing management of upper tract tumours. Nat Rev Urol 12:155–166. https://doi.org/10.1038/nrurol.2015.24CrossRefPubMed

56.

Xylinas E, Kluth L, Passoni N et al (2014) Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool. Eur Urol 65:650–658. https://doi.org/10.1016/j.eururo.2013.09.003CrossRefPubMed

57.

Sakamoto N, Naito S, Kumazawa J et al (2001) Prophylactic intravesical instillation of mitomycin C and cytosine arabinoside for prevention of recurrent bladder tumors following surgery for upper urinary tract tumors: a prospective randomized study. Int J Urol 8:212–216. https://doi.org/10.1046/j.1442-2042.2001.00286.xCrossRefPubMed

58.

Fang D, Li X‑S, Xiong G‑Y et al (2013) Prophylactic intravesical chemotherapy to prevent bladder tumors after nephroureterectomy for primary upper urinary tract urothelial carcinomas: a systematic review and meta-analysis. Urol Int 91:291–296. https://doi.org/10.1159/000350508CrossRefPubMed

59.

Rouprêt M et al (2020) Upper urinary tract urothelial cell carcinoma. 8. Follow-up. https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/#8. Zugegriffen: 03.09.2020

60.

Jeldres C, Sun M, Isbarn H et al (2010) A population-based assessment of perioperative mortality after nephroureterectomy for upper-tract urothelial carcinoma. Urology 75:315–320. https://doi.org/10.1016/j.urology.2009.10.004CrossRefPubMed

61.

Lughezzani G, Jeldres C, Isbarn H et al (2009) Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer 45:3291–3297. https://doi.org/10.1016/j.ejca.2009.06.016CrossRefPubMed

62.

Rouprêt M, Hupertan V, Seisen T et al (2013) Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis. J Urol 189:1662–1669. https://doi.org/10.1016/j.juro.2012.10.057CrossRefPubMed

63.

Motamedinia P, Keheila M, Leavitt DA et al (2016) The expanded use of percutaneous resection for upper tract urothelial carcinoma: a 30-year comprehensive experience. J Endourol 30:262–267. https://doi.org/10.1089/end.2015.0248CrossRefPubMed

64.

Bozzini G, Gastaldi C, Besana U et al (2020) Thulium-laser Retrograde Intra Renal Ablation (T-RIRA) of upper urinary tract transitional cell carcinoma: an ESUT study. Minerva Urol Nefrol. https://doi.org/10.23736/S0393-2249.20.03689-9CrossRefPubMed

65.

Chen C‑S, Li J‑R, Wang S‑S et al (2020) Tumor multifocality is a significant risk factor of urinary bladder recurrence after nephroureterectomy in patients with upper tract urothelial carcinoma: a single-institutional study. Diagnostics. https://doi.org/10.3390/diagnostics10040201CrossRefPubMedPubMedCentral

66.

Li S, Pan Y, Hu J (2019) Oncologic outcomes comparison of partial ureterectomy and radical nephroureterectomy for urothelial carcinoma. BMC Urol 19:120. https://doi.org/10.1186/s12894-019-0557-2CrossRefPubMedPubMedCentral

Titel: Urothelkarzinom des oberen Harntrakts
verfasst von: Prof. Dr. A. J. Gross
C. Netsch
J.-U. Stolzenburg
B. Becker
Publikationsdatum: 16.09.2020
Verlag: Springer Medizin
Schlagwörter: Computertomografie
Urothelkarzinom
Laparoskopie
Endoskopie der Niere und Harnwege
Ureterorenoskopie
Urografie
Computertomografie
Urothelkarzinom
Erschienen in: Die Urologie / Ausgabe 10/2020
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI: https://doi.org/10.1007/s00120-020-01323-5

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Springer Medizin

Urothelkarzinom des oberen Harntrakts

Zusammenfassung

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

CUP-Syndrom: Künstliche Intelligenz kann Primärtumor finden

Sind Frauen die fähigeren Ärzte?

Adjuvante Immuntherapie verlängert Leben bei RCC

Update Onkologie

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2020

Der nicht entscheidungsfähige chirurgische Patient

BvDU Kurz notiert

Die chirurgische Therapie der benignen Prostataobstruktion (BPO) beim antikoagulierten Patienten: eine Übersichtsarbeit über die Blutungsrisiken etablierter Techniken

Das Mikrobiom beim benignen Prostatasyndrom

Berufspolitik BvDU

Termine

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

CUP-Syndrom: Künstliche Intelligenz kann Primärtumor finden

Sind Frauen die fähigeren Ärzte?

Adjuvante Immuntherapie verlängert Leben bei RCC

Update Onkologie