腎盂尿管癌に対する腎温存手術の臨床的検討

Abstract

腎温存手術を行った腎盂尿管癌18症例(男性17例, 女性1例, 平均68.9歳)について検討した.elective case(E.case)が12例, imperative case(I.case)が6例であった.内視鏡手術は8例で, 全例E.caseであり, 生存率は良好であったが, 局所再発率は高かった.一方, 開放手術は10例(I.case:全例, E.case:4例)で, 6例が癌死した.I.caseでは, pT2以上の症例やG3症例が6例中5例であったが, E.caseでは12例中3例がpT2以上で, G3は2例であった.術後観察期間(3～104ヵ月:平均39ヵ月)の5年生存率は60%であり, E.caseが68%, I.caseが50%であった.病理学的検討では, 組織学的異型度が高くなるに従い予後が悪化する傾向がみられ, G1+2症例に比べ, G3症例の予後は不良であった.局所浸潤性腎盂尿管癌は予後不良であり, E.caseに対する腎温存手術の適応, I.caseに対するリンパ節郭清や術後補助療法などへの考慮が必要だと思われた

We reviewed 18 patients with transitional cell carcinoma of the renal pelvis and ureter undergoing nephron-sparing surgery between April 1990 and Febrary 2003. The mean age of the patients, 17 males and one female, was 69 years (range 33-88 years). The tumor site was the renal pelvis in 2, ureter in 13 and ureteral orfice in 2. Six of them were imperative cases and 12 were elective. Eight patients underwent endourological treatment and 10 patients open surgery including partial ureterectomy performed on 8 patient. The follow up period was 3 to 104 months (mean 37 months). Among those defined as imperative, the histopathological stage was pT1 in one, pT2 in one, pT3 in 3 and one in pT4. Among the elective cases, the histopathological stage was pTa in 7, pT1 in 2, pT2 in one, pT3 in 2 patients. Of the three defired as elective with tumors cT2 or higher, two died of disease. The 5-year survival rate was 50% and 68% in the imperative and elective cases, respectively. In the patients with tumors pT2 or higher and/or grade 3, the prognosis was poor which suggests the need for intensive therapy including lymph node dissection and/or adjuvant chemotherapy. It is necessary to consider the possibility of selecting nephron-sparing surgery for locally advanced tumors.