腎盂尿管癌の臨床的検討

Abstract

腎盂尿管癌62例(男48例, 女14例, 中央値67歳).発生部位は腎盂27例, 尿管24例, 腎盂尿管11例で, DIP所見は正常2例, 微小変化26例, 高度水腎症17例, 無機能腎16例であった.組織学的分類は全例移行上皮癌で, 扁平上皮癌3例, 腺癌2例を含んでいた.病理学的にはpTa, pT1の群でG2が70%, pT2以上ではG3が64.3%であった.pL, pVはpT3以上の群で各々52%, 44%にリンパ管浸潤, 脈管浸潤を認めた.1年生存率は90.8%, 3生率82.9%, 5生率68.6%であった.部位, DIP所見別にみると, 腎盂癌では高度水腎症, 無機能腎例が微小変化例に比較して生存率が有意に低かった.予後因子を単変量解析で検討したところ, G3, pT2以上, pV1, pV1で有意に生存率の低下を認め, 多変量解析ではgradeが最重要因子であった.術後化学療法は浸潤又はG3の12例とリンパ節転移の6例に行い, 再発転移は各々6例, 3例, 癌死が4例, 1例であった.膀胱癌の併発は42例で, 生存率への影響はなかった

We investigated the clinicopathological features of 62 patients with transitional cell carcinoma of the renal pelvis and/or ureter who underwent total nephroureterectomy at our department from April, 1987 to October, 2000. The patients consisted of 48 males and 14 females, with a mean age of 67 years, ranging from 46 to 86 years. The mean follow-up period was 40 months. The 1-, 3- and 5-year cause-specific survival rates (Kaplan-Meier's method) for all of the patients were 90.8, 82.9%, and 68.6%, respectively. The prognostic significance of the 5 pathological factors (grade, pT, pV, pL and pN) were evaluated. All these factors affected the survival rates significantly in univariate analysis using the generalized Wilcoxon test. According to multivariate analysis by the Cox proportional hazard model, the most influential prognostic factor was grade.