1
|
Oing C, Fankhauser CD. Hodentumoren aus klinischer Sicht. DIE PATHOLOGIE 2022; 43:434-440. [PMID: 36156132 PMCID: PMC9585009 DOI: 10.1007/s00292-022-01113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Hintergrund
Keimzelltumoren des Hodens sind die häufigste maligne Tumorerkrankung bei Männern im Alter von 15–40 Jahren. Die Unterscheidung von Seminomen und Nichtseminomen hat prognostische Bedeutung und ist für Therapieplanung und Nachsorge essenziell. Durch interdisziplinäre, stadiengerechte Therapie haben Keimzelltumoren generell eine sehr gute Prognose. Eine Übertherapie sollte wegen möglicher Langzeitfolgen vermieden werden. Hierbei hilft die Risikobeurteilung anhand klinischer und pathologischer Faktoren.
Ziel der Arbeit
Darstellung der (histo-)pathologischen Charakteristika, die die uroonkologische Therapieplanung maßgeblich beeinflussen.
Material und Methoden
Nichtsystematischer Übersichtsartikel über die relevanten (histo-)pathologischen Befunde für die klinische Therapieplanung im interdisziplinären Kontext.
Ergebnisse
Zentrale Pathologiebefunde für Kliniker:Innen sind: (i) Identifikation eines Keimzelltumors, ggf. durch Nachweis eines Chromosom-12p-Zugewinns, (ii) Subtypenspezifizierung und (iii) Angabe von Risikofaktoren (insbesondere Invasion von Lymphgefäßen und/oder Rete testis und Tumorgröße). Molekularpathologische Untersuchungen i. S. von Mutationsanalysen sind angesichts einer sehr geringen Mutationslast und bislang fehlender prädiktiver Marker und zielgerichteter Therapieoptionen nicht Teil der Routinediagnostik.
Diskussion
Ein detaillierter, idealerweise synoptischer histopathologischer Befundbericht ist Grundlage der Planung und Durchführung einer leitlinienkonformen, risikoadaptierten Therapie und neben der bildgebenden Diagnostik und der Bestimmung der Serumtumormarker AFP und β‑HCG (letztere insbesondere bei Nichtseminomen) mitentscheidend, um die guten Heilungsaussichten zu wahren und eine Übertherapie zu vermeiden.
Collapse
Affiliation(s)
- Christoph Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, NE1 7RU, Newcastle upon Tyne, Großbritannien.
- Mildred Scheel Nachwuchszentrum HaTriCS4, Universitäres Cancer Center Hamburg, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | | |
Collapse
|
2
|
Seidel C, Daugaard G, Nestler T, Tryakin A, Fedyanin M, Fankhauser CD, Hermanns T, Aparicio J, Heinzelbecker J, Paffenholz P, Heidenreich A, De Giorgi U, Cathomas R, Lorch A, Fingerhut A, Gayer F, Bremmer F, Giannatempo P, Necchi A, Raggi D, Aurilio G, Casadei C, Hentrich M, Tran B, Dieckmann KP, Brito M, Ruf C, Mazzocca A, Vincenzi B, Stahl O, Bokemeyer C, Oing C. The prognostic significance of lactate dehydrogenase levels in seminoma patients with advanced disease: an analysis by the Global Germ Cell Tumor Collaborative Group (G3). World J Urol 2021; 39:3407-3414. [PMID: 33683412 PMCID: PMC8510898 DOI: 10.1007/s00345-021-03635-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/05/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose The prognostic significance of lactate dehydrogenase (LDH) in patients with metastatic seminoma is not defined. We investigated the prognostic impact of LDH levels prior to first-line systemic treatment and other clinical characteristics in this subset of patients. Methods Files from two registry studies and one single-institution database were analyzed retrospectively. Uni- and multivariate analyses were conducted to identify patient characteristics associated with recurrence free survival (RFS), overall survival (OS), and complete response rate (CRR). Results The dataset included 351 metastatic seminoma patients with a median follow-up of 5.36 years. Five-year RFS, OS and CRR were 82%, 89% and 52%, respectively. Explorative analysis revealed a cut-off LDH level of < 2.5 upper limit of normal (ULN) (n = 228) vs. ≥ 2.5 ULN (n = 123) to be associated with a significant difference concerning OS associated with 5-years OS rates of 93% vs. 83% (p = 0.001) which was confirmed in multivariate analysis (HR 2.87; p = 0.004). Furthermore, the cut-off LDH < 2.5 ULN vs. ≥ 2.5 ULN correlated with RFS and CRR associated with a 5-years RFS rate and CRR of 76% vs. 86% (p = 0.012) and 32% vs. 59% (p ≤ 0.001), respectively. Conclusions LDH levels correlate with treatment response and survival in metastatic seminoma patients and should be considered for their prognostic stratification.
Collapse
Affiliation(s)
- Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Alexey Tryakin
- Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Mikhail Fedyanin
- Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | | | - Jorge Aparicio
- Medical Oncology Department, Hospital La Fe - On behalf of the Spanish Germ Cell Cancer Group, Valencia, Spain
| | | | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany.,Department of Urology, Medical University Vienna, Vienna, Austria
| | - Axel Heidenreich
- Department of Urology, Uro-Onology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura Dei Tumori (IRST) IRCCS - On behalf of the Italian Germ Cell Cancer Group (IGG), Meldola, Italy
| | - Richard Cathomas
- Department of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Anja Lorch
- Department of Oncology and Hematology, University Hospital Zürich, Zurich, Switzerland.,Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Anna Fingerhut
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Fabian Gayer
- Department of Urology, University Clinic Göttingen, Göttingen, Germany
| | - Felix Bremmer
- Department of Pathology, University Clinic Göttingen, Göttingen, Germany
| | | | - Andrea Necchi
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Raggi
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaetano Aurilio
- Medical Division of Urogenital and Head and Neck Cancer, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura Dei Tumori (IRST) IRCCS - On behalf of the Italian Germ Cell Cancer Group (IGG), Meldola, Italy
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Margarido Brito
- Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Christian Ruf
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | | | | | - Olof Stahl
- SWENOTECA, Trondheim, Norway.,Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Mildred Scheel Career Center HaTriCS4, University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Oing C, Peters MC, Bremmer F. [What does the oncologist need from the pathologist in testicular cancer?]. DER PATHOLOGE 2020; 41:111-117. [PMID: 33263812 DOI: 10.1007/s00292-020-00872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Testicular type II germ cell tumours (GCTs) are an exemplar of a curable cancer and the most common malignancy in males aged ≤35 years. Even in metastatic stages, about 70% of patients can be cured by cisplatin-based chemotherapy and multimodal treatments. For patients failing platinum-based standard therapy, prognosis is poor and novel biomarkers and therapeutic options are urgently needed. OBJECTIVES Discussion of desired histopathological information to guide urologists' and oncologists' decision making in the treatment of male GCTs. MATERIAL AND METHODS A narrative review of histopathological key features of male GCT tissue samples for clinical decision making. RESULTS Histopathological workup is crucial to identify (i) a GCT origin in cancers of unknown primary based on isochromosome 12p (i(12p)) detection, (ii) the different type II GCT subtypes, and (iii) risk factors, i.e. lymphovascular or rete testis invasion, among others. Proper histopathological diagnosis is indispensable for guideline-endorsed, histology-driven, and risk-adapted treatment decisions, hereby helping to maintain treatment success while reducing the therapeutic burden and potential long-term sequelae of multimodal treatments. For refractory patients failing standard treatment options, prognosis remains poor and, so far, neither predictive or prognostic biomarkers nor novel therapeutic targets have been established. CONCLUSIONS Close interaction and interdisciplinary discussion of histopathologic and radiologic findings and established risk factors including serum tumour markers is crucial for successful treatment including intensified strategies, where necessary, or prevention of overtreatment, where possible.
Collapse
Affiliation(s)
- Christoph Oing
- Klinik für Onkologie, Hämatologie und Stammzelltransplantation mit Abteilung für Pneumologie, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Mildred Scheel Nachwuchszentrum, HaTriCS4, Universitäres Cancer Center Hamburg, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Mia-Carlotta Peters
- Klinik für Onkologie, Hämatologie und Stammzelltransplantation mit Abteilung für Pneumologie, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Felix Bremmer
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| |
Collapse
|