T4腎細胞癌の臨床的検討

Abstract

T4腎細胞癌症例15例を対象とした。1)男女比は4:1, 平均年齢は63.9歳, 患側は右4, 左11で, 浸潤臓器は膵が15例中8例を占めていた。2)検査所見では, 赤沈, α-2globulin, CRPなどの予後因子が高率に異常値を示した。15例中11例に遠隔転移あるいはリンパ節転移を認めた。3) T2およびT3全症例に比べT4全症例は有意に予後不良であったが, 手術施行例だけでは両者間に有意差はなかった。4) 15例中6症例に他臓器合併切除を含めた腎摘除術を施行し, 2症例は3年以上生存した。この2症例はいずれもslow typeで遠隔転移およびリンパ節転移を認めず, PSが良好な症例であった。以上より, T4症例に対する手術適応の決定には, 臨床検査所見, 転移の有無, PSの3因子が重要な要素となる

We studied 15 patients with renal cell carcinoma invading adjacent organs (stage T4) between January 1980 and December 1991. Such invasion was four times more frequent in males than in females. The patients were between 41 and 78 years old, with a mean age of 63.9 years. The tumor was on the right side in 4 cases, and on the left side in 11 cases. Six patients (40%) presented with flank pain. The pancreas was the organ involved most frequently. Eleven patients had regional lymph node involvement or distant metastasis. Most patients had an increased erythrocyte sedimentation rate (ESR), elevated alpha-2 globulin levels, and positivity for c-reactive protein (CRP). In 6 patients, nephrectomy was extended to the abdominal or retroperitoneal structures that seemed to be invaded by tumor. Patients with T2 or T3 tumor had a significantly longer overall survival than patients with a T4 tumor. However, there was no significant difference in survival between T2/T3 tumors and T4 tumors in nephrectomized patients. Two patients who survived longer than 3 years showed no abnormalities of ESR, alpha-2 globulin and CRP. They also had no nodal or distant metastases, and had a good initial performance status. These findings suggest that extended local resection can improve the survival and quality of life for selected patients with T4 tumors.