Hartmann A, Schlomm T, Bertz S, Heinzelmann J, Hölters S, Simon R, Stoehr R, Junker K
Institut für Pathologie, Universität Erlangen, Erlangen, Deutschland.
Urologe A. 2014 Apr;53(4):491-500. doi: 10.1007/s00120-014-3442-3.
Molecular prognostic factors and genetic alterations as predictive markers for cancer-specific targeted therapies are used today in the clinic for many malignancies. In recent years, many molecular markers for urogenital cancers have also been identified. However, these markers are not clinically used yet. In prostate cancer, novel next-generation sequencing methods revealed a detailed picture of the molecular changes. There is growing evidence that a combination of classical histopathological and validated molecular markers could lead to a more precise estimation of prognosis, thus, resulting in an increasing number of patients with active surveillance as a possible treatment option. In patients with urothelial carcinoma, histopathological factors but also the proliferation of the tumor, mutations in oncogenes leading to an increasing proliferation rate and changes in genes responsible for invasion and metastasis are important. In addition, gene expression profiles which could distinguish aggressive tumors with high risk of metastasis from nonmetastasizing tumors have been recently identified. In the future, this could potentially allow better selection of patients needing systemic perioperative treatment. In renal cell carcinoma, many molecular markers that are associated with metastasis and survival have been identified. Some of these markers were also validated as independent prognostic markers. Selection of patients with primarily organ-confined tumors and increased risk of metastasis for adjuvant systemic therapy could be clinically relevant in the future.
分子预后因素和基因改变作为癌症特异性靶向治疗的预测标志物,如今已在临床上用于多种恶性肿瘤。近年来,也发现了许多泌尿生殖系统癌症的分子标志物。然而,这些标志物尚未在临床上应用。在前列腺癌中,新型的下一代测序方法揭示了分子变化的详细情况。越来越多的证据表明,经典组织病理学和经过验证的分子标志物相结合,可能会更精确地估计预后,从而使越来越多的患者有可能选择主动监测作为一种治疗方案。在尿路上皮癌患者中,组织病理学因素以及肿瘤的增殖、导致增殖率增加的癌基因突变以及负责侵袭和转移的基因变化都很重要。此外,最近还发现了能够区分具有高转移风险的侵袭性肿瘤和非转移性肿瘤的基因表达谱。未来,这可能会使选择需要全身围手术期治疗的患者变得更好。在肾细胞癌中,已经发现了许多与转移和生存相关的分子标志物。其中一些标志物也被验证为独立的预后标志物。选择主要为器官局限性肿瘤且转移风险增加的患者进行辅助全身治疗,在未来可能具有临床相关性。