多変量解析による腎盂尿管癌の予後因子の検討

Abstract

1983～1998年迄に手術を施行した腎盂尿管癌54例について, 病理学的因子と予後との関連を多変量解析により検討した.全症例の5年生存率は55.4%で, log-rank testによる検討では異型度, 深達度, 壁内リンパ管侵襲, 所属リンパ節転移が予後と有意に関連していた.Cox比例ハザードモデルによる多変量解析の結果, リンパ管侵襲のみが独立した予後因子であることが示された.リンパ管侵襲陽性例の予後は極めて不良であり, これらの症例に対する新たな治療法の開発が望まれる

We clinicopathologically reviewed 54 cases (40 males and 14 females) of renal pelvic and ureteral cancer examined between 1983 and 1998, in order to determine the impact of prognostic factors. Follow-up ranged from 2 to 173 months (mean, 45.6 months). The age of the patients ranged from 39 to 88 years (mean, 68.9 years). The 1, 3 and 5-year cause-specific survival rates (Kaplan-Meier's method) for all of the patients were 74.6%, 58.4% and 54.5%, respectively. According to univariate analysis, a high grade and high stage of tumor, the presence of lymphatic invasion and positive regional lymph nodes indicated a significantly poor prognosis. On the other hand, multivariate analysis using Cox proportional hazards regression revealed the presence of lymphatic invasion as the most significant predictor of survival. Therefore, patients with lymphatic invasion have a poor prognosis, and the development of effective adjuvant therapy is needed to improve the outcome in these patients.