腎細胞癌の予後に関する臨床的因子の検討

Abstract

自施設で経験した腎細胞癌120症例のうち観察期間(中央値3年7ヵ月)中に癌死したのは40例で, 全症例の非癌死率は5年で64.8%, 10年で56.5%であった.癌死は5年以内が36例, 5年以上が4例であった.予後因子として性, performance status(PS), 喫煙, 症状の有無, pT, pV, grade, 組織学的細胞型, 画像所見上の腫瘍最大径, 肺転移, 骨転移, リンパ節転移を検討したところ, PS0とそれ以外, 症状の有無, 腫瘍最大径5.5cm以上と未満, pT1, 2と3a以上, pV0とそれ以外, grade 2と3, 肺・骨・リンパ節転移の有無において, 各々癌死率の有意差を認めた.多変量解析で独立予後因子として認めたのはPS, pT, pV, 肺・骨・リンパ節転移であった.これらの因子のみを用いてhazard ratioを計算した結果, 骨転移, リンパ節転移, 肺転移, pV, pT, PSの順で予後への影響が大きかった

Between January 1986 and August 1996, 120 patients were diagnosed with renal cell carcinoma (RCC) at Kanagawa Cancer Center. In this study, we analyzed these patients in view of the clinicopathological factors, which affect the prognosis of these patients with univariate and multivariate analysis using Cox's proportional hazard model. Of these 120 patients, 40 patients (33%) died of RCC during this period. The cause specific survival rate was 65% after 5 years and 57% after 10 years. Univariate analysis showed some factors, performance status, symptoms, tumor size, histological grade, local invasion (pT), venous involvement (pV), lung metastasis, lymph-node metastasis, and bone metastasis, affected the prognosis. Furthermore, multivariate analysis using Cox's proportional hazard model showed that performance status, pT, pV, lung metastasis, lymphnode metastasis, and bone metastasis independently affected the prognosis. In summary, TMN factors and performance status importantly affect the prognosis of RCC patients.