腎細胞癌に対する手術・合併療法の効果と問題点

Abstract

The efficacy and problems of the surgery and adjuvant therapy of 136 patients with renal cell carcinoma who were treated at our hospital between 1953 and 1980 were reviewed. The 5-year survival rate was 45.0% for all the patients, and 72.8%, 52.2%, 34.6% and 0% for the patients with stages 1, 2, 3 and 4 cancer, respectively, the survival rate for patients with cancer at an advanced stage being poor. Clinical results of radiotherapy and combination therapy with four chemotherapeutic agents, cyclophosphamide, vincristine, methotrexate and actinomycin D used as adjuvant therapy for nephrectomy were investigated. For the patients who had stage 2 or 3 cancer, the survival rate was higher with radiotherapy, and for patients with stage 1, 2 or 3 cancer, the survival rates were improved with chemotherapy. Of the 46 patients who had stage 2 or 3 cancer, the 5-year survival rate for the 22 patients who received radiotherapy as adjuvant therapy was 62.1 %, which was superior to the 5-year survival rate (50.6%) for the other 24 patients who did not receive radiotherapy. On the other hand, of the 87 patients who had stage 1, 2 or 3 cancer, the 5-year survival rate for the 27 patients who received chemotherapy as adjuvant therapy was 81.1 % and that for the other 60 patients who did not receive adjuvant therapy was 63.1 %. The 5-year survival rate of 72.7% obtained for the 43 patients who had stage I cancer was not good. However, postoperative chemotherapy after nephrectomy by the no-touch technique and preoperative transcatheter renal arterial embolization seemed to be effective for improving survival rate. Tumor invasion into the renal vein or inferior vena cava was found in 18 patients. Four of the 6 patients who received radical operation survived 2 years and 6 months to 11 years and 5 months postoperatively. Thus, prolonged survival could be obtained even in cases showing tumor invasion into the inferior vena cava if there was no distant metastasis and if tumor thrombus could be resected. Of the 34 patients who had distant metastasis at initial examination, the survival period for the 18 patients who had undergone nephrectomy was longer than that for the 16 patients who had not been operated on. Five of the 23 patients who developed postoperative recurrence survived for 5 years and 1 month to 11 years and 5 months after the operation. These findings suggest that aggressive therapy is effective for renal cell carcinoma accompanied by metastasis.