Das muskelinvasive und metastasierte Urothelkarzinom aus Sicht der Pathologie

Zusammenfassung

Das muskelinvasive und metastasierte Urothelkarzinom ist eine heterogene Erkrankung mit breitem morphologischem und molekularem Spektrum. Mit der Novelle der WHO-Klassifikation haben sich einige Veränderungen in der Nomenklatur und Einteilung muskelinvasiver und metastasierter Urothelkarzinome ergeben. Aufgrund zunehmender Individualisierung therapeutischer Optionen gewinnt die korrekte Diagnose morphologischer Varianten des Urothelkarzinoms, die mit spezifischen molekularen Alterationen assoziiert sind, zunehmend an Bedeutung. Die morphologischen Varianten korrelieren zudem mit molekularen Subtypen des Urothelkarzinoms. Darüber hinaus sind sowohl morphologische als auch molekulare Subtypen mit immunologischen und anderen molekularen Eigenschaften assoziiert, die z.B. in Form des PD-L1- und des NECTIN-4-Status relevant für moderne Immuntherapien oder Antikörper-Drugkonjugate sein könnten. Mit der anstehenden Zulassung von Erdafitinib (FGFR3-Inhibitor) werden in Zukunft auch molekulare Tumorboards für Patienten mit metastasiertem Urothelkarzinom an Bedeutung gewinnen.

Abstract

Muscle-invasive and metastatic urothelial carcinoma is a heterogeneous disease with a broad morphological and molecular spectrum. The amendment of the WHO classification has resulted in some changes in the nomenclature and classification of muscle-invasive and metastatic urothelial carcinomas. Due to the increasing individualisation of therapeutic options, the correct diagnosis of morphological variants of urothelial carcinoma, which are associated with specific molecular alterations, is becoming more and more important. The morphological variants also correlate with molecular subtypes of urothelial carcinoma. In addition, both morphological and molecular subtypes are associated with immunological and other molecular characteristics that could be relevant for modern immunotherapies or antibody-drug conjugates, e.g. in the form of PD-L1 and NECTIN-4 status. With the pending approval of erdafitinib (FGFR3 inhibitor), molecular tumour boards for patients with metastatic urothelial carcinoma will also become more important in the future.

Schlüsselwörter

Urothelkarzinom - Molekularpathologie - histopathologische Risikofaktoren - immunologische Risikofaktoren - molekulare Subtypen

Keywords

Urothelial carcinoma - molecular pathology - histopathological risk factors - immunological risk factors - molecular subtypes

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