肉腫様腎細胞癌の臨床的検討

Abstract

肉腫成分を含む腎細胞癌について, 臨床学的検討を行った.男性9例, 女性5例の14例に対し, 初診時現症, 転移巣, 血液検査所見, 病期分類, 病理学的所見, 予後について検討を行った.初診時に何らかの症状を認めたのは13例であり, 腹部疼痛, 食思不振が各4例見られ, 転移巣が確認されたのは11例であった.肺転移7例, 所属リンパ節転移5例であった.CRPは13例で陽性であった.病期分類ではI期が1例, II期が1例, III期が2例, IV期が10例であった.根治的腎摘出術を施行した最大腫瘍直径平均は12.3cmであり, 5例に結腸, 肝臓, 小腸, 横隔膜への浸潤が見られた.組織学的異型度はgrade IIが6例, grade IIIが7例であり, 予後におけるインターフェロン使用群と非使用群の間には有意差は認められなかった

Patients with sarcomatoid renal cell carcinoma are rare and have poor survival. We evaluated 14 patients who had renal cell carcinoma with a sarcomatoid component between 1982 and 2000. There were 9 men and 5 women with a median age of 59.5 years (range 32 to 77). Seven patients had a tumor on the right side and 7 on the left side. Thirteen patients had some symptoms and 11 had metastases at the initial visit. Most of them were stage T4 and high nuclear grade cancer and showed elevated acute phase reactants. There were 7 patients followed by interferon therapy, and the cause-specific 5-year survival rate was less than 10%. We confirmed that renal cell carcinoma with a sarcomatoid component often showed local invasion, distant metastasis and poor prognosis.