Zusammenfassung
Obwohl das derzeitige Klassifikationssystem von Harnblasenkarzinomen durch Tumorstadium und -differenzierungsgrad nützliche Informationen leistet, kann der natürliche Verlauf der Erkrankung mit oder ohne Therapie nur eingeschränkt prognostiziert werden. Die Zystoskopie und Urinzytologie sind derzeit als Goldstandard in der Diagnostik und Überwachung des Harnblasenkarzinoms anzusehen. Die klassische Urinzytologie ist jedoch zumindest beim G1-Karzinom durch eine relativ niedrige Sensitivität gekennzeichnet und unterliegt einer deutlichen Untersucherabhängigkeit. Durch die Erforschung der molekularbiologischen Grundlagen von Karzinogenese und Tumorprogression wurde eine Vielzahl potentiell diagnostischer und prognostischer Marker für das Harnblasenkarzinom beschrieben. In der vorliegenden Übersichtsarbeit wurde die Literatur zu den verschiedenen Tumormarkern des Harnblasenkarzinoms im Hinblick auf deren prognostische und diagnostische Wertigkeit aktuell und umfassend dargestellt.
Schlussfolgerung: Unter der Prämisse, dass die Zystoskopie selbst nie evaluiert wurde, besteht derzeit kein diagnostischer Marker, der eine vergleichbare Sensitivität und Spezifität wie die Zystoskopie besitzt und diese ersetzen könnte. Unter den diagnostischen Markern scheint der kombinierte Nachweis mehrerer Tumorantigene, z. B. dem Immunocyt-Test, am vielversprechendsten zu sein. Solche vergleichsweise hoch sensitiven Testsysteme können möglicherweise in Zukunft die Zystoskopie bei der Nachsorge selektierter Patienten ersetzen oder Zystoskopieintervalle verlängern. Nach dem derzeitigen Stand scheint auch bei den prognostischen Markern die Kombination verschiedener Faktoren am ehesten in der Lage zu sein vorherzusagen, welche oberflächlichen Tumoren einer aggressiven Therapie und welche invasiven Tumoren einer adjuvanten Therapie bedürfen. Vielversprechend sind insgesamt die Daten zur Ki-67- und p53-Expression, dem Matrixmetalloproteinasenkomplex und der Angiogenese.
Abstract
The current system of classifying bladder carcinoma by stage and histological grade is very useful, yet still has limited ability to predict the natural history or treated natural history of a bladder tumor. Cystoscopy and urine cytology are currently considered the “gold standard” in the diagnosis and follow-up of bladder cancer. Classical urine cytology, however, at least in the diagnosis of G1-tumor, is characterized by a relatively low sensitivity. In the last few years, investigation of the basic mechanisms involved in carcinogenesis and tumor progression by molecular biology has provided a host of markers which are of potential diagnostic or prognostic value for bladder carcinoma. We provide a current, comprehensive review of the literature on bladder tumor markers and summerize their diagnostic and prognostic potential.
Conclusions: Under the premise that cystoscopy has never been subjected to evaluation, no diagnostic marker currently exists with a sensitivity and specificity comparable to cystoscopy. The combined analysis of several tumor markers as in the Immunocyt test seems to be the most promising approach. In the future these rather highly sensitive tests could replace cystoscopy or prolong the intervals between cystoscopies in the follow-up of selected patients. The literature suggests that no single marker is currently able to accurately predict the course of bladder tumors. A combination of prognostic markers could predict which superficial tumors need an aggressive form of therapy and which invasive tumors require adjuvant therapy. Altogether, the most promising markers are, at this point, Ki-67 and p53 expression as well as matrixmetalloproteinase complex and angiogenesis.
Key words:
Bladder neoplasms - Tumor markers, biological - Biology, molecular - Urinalysis - Indicators - Prognosis
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Prof. Dr. med A Böhle
Klinik für Urologie Medizinische Universität zu Lübeck
Ratzeburger Allee 160 23538 Lübeck
