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DOI: 10.1055/s-2007-966162
© Georg Thieme Verlag KG Stuttgart · New York
Gibt es tumorbiologische Besonderheiten, die ein bevorzugtes Auftreten von Rezidiven bei Kopf-Hals-Tumoren begünstigen: Tumorinvasion „revisited”[*]
What makes „Head-and-Neck-Cancers” recur: Tumorinvasion „revisited”Publication History
Publication Date:
09 March 2007 (online)
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Zusammenfassung
Karzinome der Kopf- und Halsregion sind häufige Tumoren mit schlechter Prognose, die maßgeblich von der lokoregionalen Tumorkontrolle bestimmt wird. Aus Studien der letzten Jahre geht hervor, dass nicht nur das Tumorstadium und das histologische Tumor-„grading” sondern vor allem histologische und molekularbiologische Invasion-„marker” mit einer schlechten lokoregionalen Kontrolle vergesellschaftet sind. Dazu gehört ein besonders infiltratives Wachstumsmuster, was sich histologisch durch von der Invasionsfront zum Teil abgelöste Tumorinseln und -stränge bemerkbar macht („pattern-of-invasion” Typ 4 und 5). Weitere Zeichen eines invasiven Wachstumsverhaltens des Tumors sind perineurale Invasion und das extrakapsuläre Wachstum von Lymphknotenmetastasen. Neben diesen histologischen Kennzeichen gibt es molekularbiologische Charakteristika, die die Expression von Genfamilien einschließen, deren Funktion in der lokalen Destruktion extrazellulärer Matrix liegt.
Karzinome der Kopf- und Halsregion unterscheiden sich also in ihrem Invasions- und damit vermutlich Rezidiv- und Metastasierungspotential und die lokoregionale Kontrolle scheint eine Funktion dieses biologischen Phänotyps zu sein. Das ist eine mögliche Erklärung dafür, warum in klinischen Studien der letzten Jahre die prognostische Bedeutung sogar der chirurgischen Absetzungsränder hinter die des invasiven Phänotyps zurückgefallen ist.
Abstract
Head and neck squamous cell carcinomas (HNSCC) are common cancers with a relatively poor prognosis. Locoregionale recurrences are regularly encountered and associated with a detrimental outcome. Studies of the last few years report that not only tumor staging and grading influence locoregional control but also histologic and biological markers. One such histological marker is coined ”worst pattern of invasion”. It describes a histologic growth pattern consisting of invading tumor cell islands and strands that are dispatched from the invasion front (POI typ 4 and 5). Additional features of invasion are perineural invasion and extracapsular nodal extension. Besides histological markers there are molecular characteristics that include the expression of gene families involved in extracellular matrix degradation.
The data suggest that head and neck cancers differ with respect to their invasive growth capacity and thus their ability to generate locoregionale recurrences. It appears that locoregionale control is a consequence of this growth pattern. This may explain, why in recent clincial studies the prognostic marker ”pattern-of-invasion“ outweights even such well established prognosticators such as ”surgical margins“.
1 This work was supported by the Fortune program of the University of Tübingen (889-1-0), a DFG grant (Si 634-2/2, Si 634-4/1) and Else-Übermesser Grant (0415-221) to C. Simon.
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1 This work was supported by the Fortune program of the University of Tübingen (889-1-0), a DFG grant (Si 634-2/2, Si 634-4/1) and Else-Übermesser Grant (0415-221) to C. Simon.
PD Dr. Christian Simon
HNO-Universitätsklinik Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg
Email: Christian.Simon@med.uni-heidelberg.de