Pathologische Diagnostik und Biomarker für die perioperative Systemtherapie

Zusammenfassung

Eine optimale personalisierte Planung der Therapie beim resezierbaren Lungenkarzinom erfordert eine qualitätsgesicherte, standardisierte und zeitnahe Aufarbeitung von Gewebeproben in pathologischen Laboren sowie die Bestimmung relevanter prädiktiver und prognostischer Biomarker. Die pathologische Diagnostik umfasst die histologische Tumortypisierung, Stadieneinteilung und Tumorgraduierung, Resektionsstatus und ggf. Regressionsgraduierung bei Z. n. neoadjuvanter Systemtherapie. Die histopathologische Typisierung erfolgt nach aktuell gültiger WHO-Klassifikation und umfasst u. a. Adenokarzinome, Plattenepithelkarzinome, andere nicht kleinzellige Lungenkarzinome (NSCLCs), Karzinoide, kleinzellige und großzellige neuroendokrine Karzinome. Eine standardisierte Tumorgraduierung spielt derzeit vor allem beim invasiven nicht muzinösen Adenokarzinom eine wichtige Rolle und ermöglicht eine prognostische Risikoeinschätzung. Ebenso sind die R-Klassifikation und die Regressionsgraduierung prognostisch relevant. In den frühen Stadien des NSCLC sind molekulare Biomarker wie EGFR, ALK und PD-L1 relevant für eine personalisierte Therapieentscheidung. Die Testung erfolgt an FFPE-Gewebeproben und ist qualitätsgesichert gemäß internationalem Standard durchzuführen.

Abstract

Optimal personalized treatment planning for resectable lung cancer requires quality-assured, standardized and prompt processing of tissue samples in pathological laboratories, as well as the determination of relevant predictive and prognostic biomarkers. Pathological diagnostic testing includes histological tumor typing, staging and tumor grading, resection status and, if necessary, regression grading after neoadjuvant systemic therapy. Histopathological typing is performed according to the current WHO classification and includes adenocarcinomas, squamous cell carcinomas, other non-small cell lung carcinomas (NSCLCs), carcinoids, small cell and large cell neuroendocrine carcinomas. Standardized tumor grading currently plays an important role in invasive non-mucinous adenocarcinoma in particular and enables prognostic risk assessment. The R classification and regression grading are also prognostically relevant. In the early stages of NSCLC, molecular biomarkers such as EGFR, ALK and PD-L1, are relevant for decisions on individual treatment. Testing is performed on FFPE tissue samples and must be carried out in a quality-assured manner and in accordance with international standards.

Schlüsselwörter

Lungenkarzinom - Pathologie - prädiktive Biomarker - NSCLC - Immuncheckpoint-Inhibitor

Keywords

lung cancer - NSCLC - predictive biomarker - pathology - immune checkpoint inhibitor

Publication History

Received: 30 April 2024

Accepted after revision: 01 July 2024

Article published online:
13 August 2024

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