Pathologische Risikostratifizierung des nicht muskelinvasiven und muskelinvasiven Urothelkarzinoms zur optimalen Therapieentscheidung

Zusammenfassung

Die Therapie des Urothelkarzinoms befindet sich in einem rasanten Wandel. Sowohl für das nicht muskelinvasive Urothelkarzinom (NMIBC) als auch das muskelinvasive Urothelkarzinom (MIBC) werden moderne Substanzen in verschiedenen Therapiekonzepten zur Senkung der Rezidiv- und Progressionsrisiken als auch zur Steigerung der Blasenerhaltsraten (insbesondere beim MIBC bzw. beim BCG-refraktären high/very high risk NMIBC) getestet. Hierbei spielen insbesondere Antikörper-Wirkstoff-Konjugate (ADC) wie Enfortumab Vedotin und neue Immuntherapien eine zentrale Rolle. Kontrovers bleibt allerdings nach welchen Maßgaben Patienten mit NMIBC mittels Frühzystektomie bzw. Patienten mit MIBC blasenerhaltend therapiert werden sollten bzw. könnten. Die vorliegende Arbeit beleuchtet die derzeit geltenden Therapiestandards in diesem kontroversen Kontext und geht dabei auf potenzielle histopathologische sowie molekulare Stratifizierungshilfen ein, um künftig eine gezieltere Patientenselektion zu ermöglichen und lenken zu können.

Abstract

The treatment of urothelial carcinoma is undergoing rapid change. For both non-muscle-invasive urothelial carcinoma (NMIBC) and muscle-invasive urothelial carcinoma (MIBC), state-of-the-art substances are being tested in various therapy concepts to reduce the risk of recurrence and progression and to increase bladder preservation rates (particularly in muscle-invasive urothelial carcinoma and BCG-refractory high/very high-risk pT1 carcinoma). Antibody-drug conjugates such as enfortumab vedotin, as well as new immunotherapies, play a key role in this context. However, it remains controversial according to which criteria patients with NMIBC should undergo early cystectomy and patients with MIBC should receive bladder-preserving therapy. This paper attempts to discuss the current treatment standards in this controversial context and to address possible histopathological and molecular stratification tools that could improve or guide this selection in the future.

Schlüsselwörter

nicht muskelinvasives Urothelkarzinom - muskelinvasives Urothelkarzinom - Risikostratifizierung - Präzisionsonkologie - Biomarker

Keywords

non-muscle-invasive urothelial carcinoma - muscle-invasive urothelial carcinoma - risk stratification - precision oncology - biomarkers

Publication History

Received: 05 May 2025

Accepted after revision: 23 September 2025

Article published online:
23 October 2025

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