M0腎細胞癌における腫瘍径と所属リンパ節転移 - リンパ節郭清例での検討 -

Abstract

遠隔転移のない腎細胞癌でリンパ節郭清を施行した症例において, 腫瘍サイズ, 術前CTでのリンパ節所見, 発見契機とリンパ節転移との関係について検討した.その結果, 1)術前の画像診断上, 腫瘍サイズが比較的小さく臨床的にリンパ節転移が陰性の症例であったとしても, 開腹手術の適応となる腫瘍サイズの大きな症例と同様に数%に病理学的リンパ節転移陽性例が存在した.2)リンパ節郭清により長期予後が改善したと考えられた患者は0.9%であった.3)腫瘍サイズや術前画像所見を問わず, リンパ節転移の可能性があることから, 現時点では可能性であれば, リンパ節郭清を行うことは妥当であると考えられた

We evaluated the relationship between regional lymph node metastasis and tumor size in patients with M0 renal cell carcinoma who received regional lymph node dissection. The study involved 234 of the 247 patients with localized renal cell carcinoma who underwent radical nephrectomy with lymph node dissection at our institute between 1985 and 1999. Patients were arbitrarily classified into 3 groups by the greatest diameter of the tumor on preoperative computed tomography (CT): 4.0 cm or less (group A), 4.1 to 7.0 cm (group B), and 7.1 cm or more (group C). The incidence of lymph node metastasis was assessed in each group. The current study showed that 11 (4.7%) of the 234 patients with lymph node dissection together with radical nephrectomy were lymph node positive. The incidences of lymph node metastasis were 4.0% in group A, 2.3% in group B, and 8.4% in group C (p = 0.79). Of these 11 patients with lymph node metastasis, 2 (18.2%) have so far survived for over 5 years following surgery. Although the role of regional lymph node dissection with radical nephrectomy might be limited and controversial in renal cell carcinoma, urological surgeons should always be aware of possible metastasis for any tumor size.