Skip to main content
Erschienen in: Der Urologe 3/2018

27.02.2018 | Nierenkarzinom | Leitthema

„Watchful waiting“ und aktive Überwachung kleiner Nierentumoren

verfasst von: Dr. R. Mager, S. Frees, A. Haferkamp

Erschienen in: Die Urologie | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Inzidenz kleiner Nierenzellkarzinome ≤4 cm steigt mit der ausgedehnten Nutzung von Schnittbildgebung. Die Tumoren weisen meist wenig Aggressivität auf, wobei das Risiko der Metastasierung trotzdem bis zu 6 % betragen kann. Insbesondere für alte komorbide Patienten könnte eine Operation somit eine schädigende Übertherapie darstellen. Die Etablierung einer onkologisch sicheren aktiven Überwachung gewinnt in dieser Situation zunehmend an Bedeutung, so dass klinische, radiologische und biopsiebasierte biologische Marker für die Auswahl und die Überwachung geeigneter Patienten aktuell im Fokus der Forschung stehen.
Literatur
1.
Zurück zum Zitat Audenet F, Audouin M, Drouin SJ et al (2014) Charlson score as a single pertinent criterion to select candidates for active surveillance among patients with small renal masses. World J Urol 32:513–518CrossRefPubMed Audenet F, Audouin M, Drouin SJ et al (2014) Charlson score as a single pertinent criterion to select candidates for active surveillance among patients with small renal masses. World J Urol 32:513–518CrossRefPubMed
2.
Zurück zum Zitat AWMF, DKG, Deutsche Krebshilfe (2017) S3-Leitlinie Nierenzellkarzinom. Leitlinienprogramm Onkologie AWMF-Registernummer: 043/017-OL AWMF, DKG, Deutsche Krebshilfe (2017) S3-Leitlinie Nierenzellkarzinom. Leitlinienprogramm Onkologie AWMF-Registernummer: 043/017-OL
3.
Zurück zum Zitat Beroukhim R, Brunet JP, Di Napoli A et al (2009) Patterns of gene expression and copy-number alterations in von-hippel lindau disease-associated and sporadic clear cell carcinoma of the kidney. Cancer Res 69:4674–4681CrossRefPubMedPubMedCentral Beroukhim R, Brunet JP, Di Napoli A et al (2009) Patterns of gene expression and copy-number alterations in von-hippel lindau disease-associated and sporadic clear cell carcinoma of the kidney. Cancer Res 69:4674–4681CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Cancer Genome Atlas Research Network (2013) Comprehensive molecular characterization of clear cell renal cell carcinoma. Nature 499:43–49CrossRef Cancer Genome Atlas Research Network (2013) Comprehensive molecular characterization of clear cell renal cell carcinoma. Nature 499:43–49CrossRef
6.
Zurück zum Zitat Chow WH, Devesa SS, Warren JL et al (1999) Rising incidence of renal cell cancer in the United States. JAMA 281:1628–1631CrossRefPubMed Chow WH, Devesa SS, Warren JL et al (1999) Rising incidence of renal cell cancer in the United States. JAMA 281:1628–1631CrossRefPubMed
7.
Zurück zum Zitat Gerlinger M, Rowan AJ, Horswell S et al (2012) Intratumor heterogeneity and branched evolution revealed by multiregion sequencing. N Engl J Med 366:883–892CrossRefPubMedPubMedCentral Gerlinger M, Rowan AJ, Horswell S et al (2012) Intratumor heterogeneity and branched evolution revealed by multiregion sequencing. N Engl J Med 366:883–892CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Gerlinger M, Horswell S, Larkin J et al (2014) Genomic architecture and evolution of clear cell renal cell carcinomas defined by multiregion sequencing. Nat Genet 46:225–233CrossRefPubMedPubMedCentral Gerlinger M, Horswell S, Larkin J et al (2014) Genomic architecture and evolution of clear cell renal cell carcinomas defined by multiregion sequencing. Nat Genet 46:225–233CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Gibney GT, Aziz SA, Camp RL et al (2013) c‑Met is a prognostic marker and potential therapeutic target in clear cell renal cell carcinoma. Ann Oncol 24:343–349CrossRefPubMed Gibney GT, Aziz SA, Camp RL et al (2013) c‑Met is a prognostic marker and potential therapeutic target in clear cell renal cell carcinoma. Ann Oncol 24:343–349CrossRefPubMed
10.
Zurück zum Zitat Hakimi AA, Chen YB, Wren J et al (2013) Clinical and pathologic impact of select chromatin-modulating tumor suppressors in clear cell renal cell carcinoma. Eur Urol 63:848–854CrossRefPubMed Hakimi AA, Chen YB, Wren J et al (2013) Clinical and pathologic impact of select chromatin-modulating tumor suppressors in clear cell renal cell carcinoma. Eur Urol 63:848–854CrossRefPubMed
11.
Zurück zum Zitat Hakimi AA, Ostrovnaya I, Reva B et al (2013) Adverse outcomes in clear cell renal cell carcinoma with mutations of 3p21 epigenetic regulators BAP1 and SETD2: a report by MSKCC and the KIRC TCGA research network. Clin Cancer Res 19:3259–3267CrossRefPubMedPubMedCentral Hakimi AA, Ostrovnaya I, Reva B et al (2013) Adverse outcomes in clear cell renal cell carcinoma with mutations of 3p21 epigenetic regulators BAP1 and SETD2: a report by MSKCC and the KIRC TCGA research network. Clin Cancer Res 19:3259–3267CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Halverson SJ, Kunju LP, Bhalla R et al (2013) Accuracy of determining small renal mass management with risk stratified biopsies: confirmation by final pathology. J Urol 189:441–446CrossRefPubMed Halverson SJ, Kunju LP, Bhalla R et al (2013) Accuracy of determining small renal mass management with risk stratified biopsies: confirmation by final pathology. J Urol 189:441–446CrossRefPubMed
13.
Zurück zum Zitat Hollingsworth JM, Miller DC, Daignault S et al (2006) Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 98:1331–1334CrossRefPubMed Hollingsworth JM, Miller DC, Daignault S et al (2006) Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 98:1331–1334CrossRefPubMed
14.
Zurück zum Zitat Ibragimova I, Maradeo ME, Dulaimi E et al (2013) Aberrant promoter hypermethylation of PBRM1, BAP1, SETD2, KDM6A and other chromatin-modifying genes is absent or rare in clear cell RCC. Epigenetics 8:486–493CrossRefPubMedPubMedCentral Ibragimova I, Maradeo ME, Dulaimi E et al (2013) Aberrant promoter hypermethylation of PBRM1, BAP1, SETD2, KDM6A and other chromatin-modifying genes is absent or rare in clear cell RCC. Epigenetics 8:486–493CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Jewett MA, Mattar K, Basiuk J et al (2011) Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol 60:39–44CrossRefPubMed Jewett MA, Mattar K, Basiuk J et al (2011) Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol 60:39–44CrossRefPubMed
17.
Zurück zum Zitat Joseph RW, Kapur P, Serie DJ et al (2014) Loss of BAP1 protein expression is an independent marker of poor prognosis in patients with low-risk clear cell renal cell carcinoma. Cancer 120:1059–1067CrossRefPubMed Joseph RW, Kapur P, Serie DJ et al (2014) Loss of BAP1 protein expression is an independent marker of poor prognosis in patients with low-risk clear cell renal cell carcinoma. Cancer 120:1059–1067CrossRefPubMed
18.
Zurück zum Zitat Kapur P, Christie A, Raman JD et al (2014) BAP1 immunohistochemistry predicts outcomes in a multi-institutional cohort with clear cell renal cell carcinoma. J Urol 191:603–610CrossRefPubMed Kapur P, Christie A, Raman JD et al (2014) BAP1 immunohistochemistry predicts outcomes in a multi-institutional cohort with clear cell renal cell carcinoma. J Urol 191:603–610CrossRefPubMed
19.
Zurück zum Zitat Klatte T, Seligson DB, Larochelle J et al (2009) Molecular signatures of localized clear cell renal cell carcinoma to predict disease-free survival after nephrectomy. Cancer Epidemiol Biomarkers Prev 18:894–900CrossRefPubMed Klatte T, Seligson DB, Larochelle J et al (2009) Molecular signatures of localized clear cell renal cell carcinoma to predict disease-free survival after nephrectomy. Cancer Epidemiol Biomarkers Prev 18:894–900CrossRefPubMed
20.
Zurück zum Zitat Kroeger N, Klatte T, Chamie K et al (2013) Deletions of chromosomes 3p and 14q molecularly subclassify clear cell renal cell carcinoma. Cancer 119:1547–1554CrossRefPubMed Kroeger N, Klatte T, Chamie K et al (2013) Deletions of chromosomes 3p and 14q molecularly subclassify clear cell renal cell carcinoma. Cancer 119:1547–1554CrossRefPubMed
21.
Zurück zum Zitat Kunkle DA, Crispen PL, Chen DY et al (2007) Enhancing renal masses with zero net growth during active surveillance. J Urol 177:849–853 (discussion 853–844)CrossRefPubMed Kunkle DA, Crispen PL, Chen DY et al (2007) Enhancing renal masses with zero net growth during active surveillance. J Urol 177:849–853 (discussion 853–844)CrossRefPubMed
22.
Zurück zum Zitat Lang K, Danchenko N, Gondek K et al (2007) The burden of illness associated with renal cell carcinoma in the United States. Urol Oncol 25:368–375CrossRefPubMed Lang K, Danchenko N, Gondek K et al (2007) The burden of illness associated with renal cell carcinoma in the United States. Urol Oncol 25:368–375CrossRefPubMed
23.
Zurück zum Zitat Lee H, Lee JK, Kim K et al (2016) Risk of metastasis for T1a renal cell carcinoma. World J Urol 34:553–559CrossRefPubMed Lee H, Lee JK, Kim K et al (2016) Risk of metastasis for T1a renal cell carcinoma. World J Urol 34:553–559CrossRefPubMed
24.
25.
26.
Zurück zum Zitat Lonser RR, Glenn GM, Walther M et al (2003) von Hippel-Lindau disease. Lancet 361:2059–2067CrossRefPubMed Lonser RR, Glenn GM, Walther M et al (2003) von Hippel-Lindau disease. Lancet 361:2059–2067CrossRefPubMed
28.
29.
Zurück zum Zitat Osawa T, Hafez KS, Miller DC, Montgomery JS, Morgan TM, Palapattu GS, Weizer AZ, Caoili EM, Ellis JH, Kunju LP, Wolf JS (2016) Age, Gender and R.E.N.A.L. Nephrometry Score do not Improve the Accuracy of a Risk Stratification Algorithm Based on Biopsy and Mass Size for Assigning Surveillance versus Treatment of Renal Tumors. J Urol 195(3):574–580PubMed Osawa T, Hafez KS, Miller DC, Montgomery JS, Morgan TM, Palapattu GS, Weizer AZ, Caoili EM, Ellis JH, Kunju LP, Wolf JS (2016) Age, Gender and R.E.N.A.L. Nephrometry Score do not Improve the Accuracy of a Risk Stratification Algorithm Based on Biopsy and Mass Size for Assigning Surveillance versus Treatment of Renal Tumors. J Urol 195(3):574–580PubMed
30.
Zurück zum Zitat Parker PA, Alba F, Fellman B et al (2013) Illness uncertainty and quality of life of patients with small renal tumors undergoing watchful waiting: a 2-year prospective study. Eur Urol 63:1122–1127CrossRefPubMed Parker PA, Alba F, Fellman B et al (2013) Illness uncertainty and quality of life of patients with small renal tumors undergoing watchful waiting: a 2-year prospective study. Eur Urol 63:1122–1127CrossRefPubMed
31.
Zurück zum Zitat Paterson C, Yew-Fung C, Sweeney C et al (2017) Predictors of growth kinetics and outcomes in small renal masses (SRM 〈/=4 cm in size): tayside active surveillance cohort (TASC) study. Eur J Surg Oncol 43:1589–1597CrossRefPubMed Paterson C, Yew-Fung C, Sweeney C et al (2017) Predictors of growth kinetics and outcomes in small renal masses (SRM 〈/=4 cm in size): tayside active surveillance cohort (TASC) study. Eur J Surg Oncol 43:1589–1597CrossRefPubMed
32.
33.
Zurück zum Zitat Pierorazio PM, Johnson MH, Ball MW et al (2015) Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol 68:408–415CrossRefPubMed Pierorazio PM, Johnson MH, Ball MW et al (2015) Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol 68:408–415CrossRefPubMed
34.
Zurück zum Zitat Rendon RA, Stanietzky N, Panzarella T et al (2000) The natural history of small renal masses. J Urol 164:1143–1147CrossRefPubMed Rendon RA, Stanietzky N, Panzarella T et al (2000) The natural history of small renal masses. J Urol 164:1143–1147CrossRefPubMed
35.
Zurück zum Zitat Robert Koch Institut (2015) Krebs in Deutschland. In: Krebsregisterdaten. Robert Koch Institut, Berlin S 102–105 Robert Koch Institut (2015) Krebs in Deutschland. In: Krebsregisterdaten. Robert Koch Institut, Berlin S 102–105
36.
Zurück zum Zitat La Rochelle J, Klatte T, Dastane A et al (2010) Chromosome 9p deletions identify an aggressive phenotype of clear cell renal cell carcinoma. Cancer 116:4696–4702CrossRefPubMed La Rochelle J, Klatte T, Dastane A et al (2010) Chromosome 9p deletions identify an aggressive phenotype of clear cell renal cell carcinoma. Cancer 116:4696–4702CrossRefPubMed
37.
Zurück zum Zitat Sato Y, Yoshizato T, Shiraishi Y et al (2013) Integrated molecular analysis of clear-cell renal cell carcinoma. Nat Genet 45:860–867CrossRefPubMed Sato Y, Yoshizato T, Shiraishi Y et al (2013) Integrated molecular analysis of clear-cell renal cell carcinoma. Nat Genet 45:860–867CrossRefPubMed
38.
Zurück zum Zitat Shuch B, Hanley JM, Lai JC et al (2014) Adverse health outcomes associated with surgical management of the small renal mass. J Urol 191:301–308CrossRefPubMed Shuch B, Hanley JM, Lai JC et al (2014) Adverse health outcomes associated with surgical management of the small renal mass. J Urol 191:301–308CrossRefPubMed
39.
Zurück zum Zitat Smaldone MC, Kutikov A, Egleston BL et al (2012) Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 118:997–1006CrossRefPubMed Smaldone MC, Kutikov A, Egleston BL et al (2012) Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 118:997–1006CrossRefPubMed
40.
Zurück zum Zitat Smaldone MC, Corcoran AT, Uzzo RG (2013) Active surveillance of small renal masses. Nat Rev Urol 10:266–274CrossRefPubMed Smaldone MC, Corcoran AT, Uzzo RG (2013) Active surveillance of small renal masses. Nat Rev Urol 10:266–274CrossRefPubMed
41.
Zurück zum Zitat Sun M, Abdollah F, Bianchi M et al (2012) Treatment management of small renal masses in the 21st century: a paradigm shift. Ann Surg Oncol 19:2380–2387CrossRefPubMed Sun M, Abdollah F, Bianchi M et al (2012) Treatment management of small renal masses in the 21st century: a paradigm shift. Ann Surg Oncol 19:2380–2387CrossRefPubMed
43.
Zurück zum Zitat Varela I, Tarpey P, Raine K et al (2011) Exome sequencing identifies frequent mutation of the SWI/SNF complex gene PBRM1 in renal carcinoma. Nature 469:539–542CrossRefPubMedPubMedCentral Varela I, Tarpey P, Raine K et al (2011) Exome sequencing identifies frequent mutation of the SWI/SNF complex gene PBRM1 in renal carcinoma. Nature 469:539–542CrossRefPubMedPubMedCentral
44.
Zurück zum Zitat Volpe A, Panzarella T, Rendon RA et al (2004) The natural history of incidentally detected small renal masses. Cancer 100:738–745CrossRefPubMed Volpe A, Panzarella T, Rendon RA et al (2004) The natural history of incidentally detected small renal masses. Cancer 100:738–745CrossRefPubMed
45.
Zurück zum Zitat Volpe A, Kachura JR, Geddie WR et al (2007) Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 178:379–386CrossRefPubMed Volpe A, Kachura JR, Geddie WR et al (2007) Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 178:379–386CrossRefPubMed
46.
Zurück zum Zitat Volpe A, Finelli A, Gill IS et al (2012) Rationale for percutaneous biopsy and histologic characterisation of renal tumours. Eur Urol 62:491–504CrossRefPubMed Volpe A, Finelli A, Gill IS et al (2012) Rationale for percutaneous biopsy and histologic characterisation of renal tumours. Eur Urol 62:491–504CrossRefPubMed
47.
Zurück zum Zitat Walther MM, Choyke PL, Glenn G et al (1999) Renal cancer in families with hereditary renal cancer: prospective analysis of a tumor size threshold for renal parenchymal sparing surgery. J Urol 161:1475–1479CrossRefPubMed Walther MM, Choyke PL, Glenn G et al (1999) Renal cancer in families with hereditary renal cancer: prospective analysis of a tumor size threshold for renal parenchymal sparing surgery. J Urol 161:1475–1479CrossRefPubMed
48.
49.
Zurück zum Zitat Zhang XC, Xu C, Mitchell RM et al (2013) Tumor evolution and intratumor heterogeneity of an oropharyngeal squamous cell carcinoma revealed by whole-genome sequencing. Neoplasia 15:1371–1378CrossRefPubMedPubMedCentral Zhang XC, Xu C, Mitchell RM et al (2013) Tumor evolution and intratumor heterogeneity of an oropharyngeal squamous cell carcinoma revealed by whole-genome sequencing. Neoplasia 15:1371–1378CrossRefPubMedPubMedCentral
Metadaten
Titel
„Watchful waiting“ und aktive Überwachung kleiner Nierentumoren
verfasst von
Dr. R. Mager
S. Frees
A. Haferkamp
Publikationsdatum
27.02.2018
Verlag
Springer Medizin
Erschienen in
Die Urologie / Ausgabe 3/2018
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-018-0584-8

Weitere Artikel der Ausgabe 3/2018

Der Urologe 3/2018 Zur Ausgabe

Mitteilungen der DGU

Mitteilungen der DGU

GeSRU

GeSRU

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.